Nationwide validation of the distal fistula risk score (D-FRS)

Eduard A. van Bodegraven, Femke E.T. den Haring, Britt Pollemans, Damaris Monselis, Matteo De Pastena, Casper van Eijck, Freek Daams, Ignace de Hingh, Misha Luyer, Martijn W.J. Stommel, Hjalmar C. van Santvoort, S. Festen, J. S.D. Mieog, J. Klaase, D. Lips, M. M.E. Coolsen, G. P. van der Schelling, E. R. Manusama, G. Patijn, E. van der HarstK. Bosscha, Giovanni Marchegiani, Marc G. Besselink*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Distal pancreatectomy (DP) is associated with a high complication rate of 30–50% with postoperative pancreatic fistula (POPF) as a dominant contributor. Adequate risk estimation for POPF enables surgeons to use a tailor-made approach. Assessment of the risk of POPF prior to DP can lead to the application of preventive strategies. The current study aims to validate the recently published preoperative and intraoperative distal fistula risk score (D-FRS) in a nationwide cohort.

This nationwide retrospective Dutch cohort study included all patients after DP for any indication, all of whom were registered in the Dutch Pancreatic Cancer Audit (DPCA) database between 2013 and 2021. The D-FRS was validated by filling in the probability equations with data from this cohort. The predictive capacity of the models was represented by an area under the receiver operating characteristic (AUROC) curve.

A total of 896 patients underwent DP of which 152 (17%) developed POPF of whom 144 grade B (95%) and 8 grade C (5%). The preoperative D-FRS, consisting of the variables pancreatic neck thickness and pancreatic duct diameter, showed an AUROC of 0.73 (95%CI 0.68–0.78). The intraoperative D-FRS, comprising pancreatic neck, duct diameter, BMI, operating time, and soft pancreatic aspect, showed an AUROC of 0.69 (95%CI 0.64–0.74).

The current study is the first nationwide validation of the preoperative and intraoperative D-FRS showing acceptable distinguishing capacity for only the preoperative D-FRS for POPF. Therefore, the preoperative score could improve prevention and mitigation strategies such as drain management, which is currently investigated in the multicenter PANDORINA trial.

Original languageEnglish
Article number14
JournalLangenbeck's Archives of Surgery
Issue number14
Publication statusPublished - 20 Dec 2024

Bibliographical note

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.


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