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ISSN 1405-0099 (Print)

2025, Number 1

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Cir Gen 2025; 47 (1)

Comparison of scales predicting mortality in postoperative pancreatoduodenectomy patients in a Mexican population

Salas TB, Nacud BYA, Guzmán CEI, Salas FDI, Álamo HMV

Language: Spanish
References: 18
Page: 13-20
PDF size: 405.09 Kb.


ABSTRACT

Introduction: pancreatoduodenectomy has a mortality rate between 2 to 10%. Preoperative mortality risk assessment allows better selection of cases in whom surgery represents minimum risk and maximum benefit. Objective: to find the best scoring system to predict mortality among patients undergoing pancreatoduodenectomy in our hospital. Material and methods: an observational, longitudinal, retrospective study was performed with records of patients who underwent pancreatoduodenectomy during 2019 to 2024. Information was extracted to apply the predictive scales: Whipple-ABACUS, Pitt and modified Pitt. The vital status of the patient 30 days after surgery was recorded. Results: forty-three cases were included. Five cases (11.63%) died during the 30-day follow-up. The area under the curve (AUC) estimated by each scale was: Pitt, AUC 0.962, 95% confidence interval (95%CI) 0.907-1.000; modified Pitt, AUC 0.955, 95%CI 0.895-100; and finally, Whipple-ABACUS, AUC 0.779, 95%CI 0.610-0.948. The best cut-off points per scale for predicting death were: Pitt: ≥ 5 points, modified Pitt: ≥ 3 points, Whipple-ABACUS: ≥ 2 points. Conclusions: the Pitt and modified Pitt scales are the most useful for predicting death at 30 days post pancreatoduodenectomy.


REFERENCES

  1. Navarro S. Descubrimientos y técnicas que han contribuido a mejorar el tratamiento de las enfermedades pancreáticas. Gastroenterol Hepatol. 2015; 38: 330-337.

  2. Busnardo AC, DiDio LJ, Tidrick RT, Thomford NR. History of the pancreas. Am J Surg. 1983; 146: 539-550.

  3. Yim C. Surgical considerations of pancreaticoduodenectomy, its medical indications and contraindications. Med Surg Urol. 2023;12: 314.

  4. Hasan S, Abel S, Verma V, Schiffman S, Thakkar S, Kulkarni A, et al. Predictors of post-operative mortality following pancreatectomy: a contemporary nationwide analysis. Journal of Clinical Oncology. 2019; 37: e15706-6.

  5. Hashemzadeh S, Mehrafsa B, Kakaei F, Javadrashid R, Golshan R, Seifar F, et al. Diagnostic accuracy of a 64-slice multi-detector CT scan in the preoperative evaluation of periampullary neoplasms. J Clin Med. 2018; 7: 91.

  6. Zheng-Pywell R, Reddy S. Ampullary cancer. Surg Clin North Am. 2019; 99: 357-367.

  7. Panzeri F. Management of ampullary neoplasms: a tailored approach between endoscopy and surgery. World J Gastroenterol. 2015; 21: 7970-7987.

  8. Podda M, Thompson J, Kulli CTG, Tait IS. Vascular resection in pancreaticoduodenectomy for periampullary cancers. A 10 year retrospective cohort study. Int J Surg. 2017; 39: 37-44.

  9. Wiltberger G, Krenzien F, Atanasov G, Hau HM, Schmelzle M, Bartels M, et al. Pancreaticoduodenectomy for periampullary cancer: does the tumour entity influence perioperative morbidity and long-term outcome? Acta Chir Belg. 2018; 118: 341-347.

  10. Chen T, Wang H, Wang H, Song Y, Li X, Wang J. POSSUM and P-POSSUM as predictors of postoperative morbidity and mortality in patients undergoing hepato-biliary-pancreatic surgery: a meta-analysis. Ann Surg Oncol. 2013; 20: 2501-2510.

  11. Balzano G, Guarneri G, Pecorelli N, Paiella S, Rancoita PMV, Bassi C, et al. Modelling centralization of pancreatic surgery in a nationwide analysis. Br J Surg. 2020; 107: 1510-1519.

  12. Gleeson EM, Shaikh MF, Shewokis PA, Clarke JR, Meyers WC, Pitt HA, et al. WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database. Surgery. 2016; 160: 1279-1287.

  13. Chan C, Franssen B, Rubio A, Uscanga L. Pancreaticoduodenectomy in a Latin American country: the transition to a high-volume center. J Gastrointest Surg. 2008; 12: 527-533.

  14. Nugroho A, Lalisang TJM. Validation of simplified predictive score for postoperative mortality after pancreaticoduodenectomy. Med J Indones. 2014; 23: 87-92.

  15. Lalisang ANL, Nugroho A, Putranto AS, Mazni Y, Lalisang TJM. Keep it or leave it? Comparison of preoperative scoring as mortality predictor post-pancreaticoduodenectomy. Asian Pac J Cancer Prev. 2023; 24: 2885-2893.

  16. Gazivoda VP, Kennedy TJ. Risk Factors for Post-Pancreaticoduodenectomy Mortality: Identification and Mitigation. Open Access Surgery. 2024; 17: 63-71

  17. Franko J, Hsu HW, Thirunavukarasu P, Frankova D, Goldman CD. Chemotherapy and radiation components of neoadjuvant treatment of pancreatic head adenocarcinoma: impact on perioperative mortality and long-term survival. Eur J Surg Oncol. 2017; 43: 351-357.

  18. Narayanan S, Martin AN, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J Surg Res. 2018; 231: 304-308.




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