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- Title
Prospective study on predictability of complications by pancreatic surgeons.
- Authors
Vanbrugghe, Charles; Birnbaum, David Jérémie; Boucekine, Mohamed; Ewald, Jacques; Marchese, Ugo; Guilbaud, Théophile; Berdah, Stéphane Victor; Moutardier, Vincent
- Abstract
Purpose: We evaluated the intuition of expert pancreatic surgeons, in predicting the associated risk of pancreatic resection and compared this "intuition" to actual operative follow-up. The objective was to avoid major complications following pancreatic resection, which remains a challenge. Methods: From January 2015 to February 2018, all patients who were 18 years old or more undergoing a pancreatic resection (pancreaticoduodenectomy [PD], distal pancreatectomy [DP], or central pancreatectomy [CP]) for pancreatic lesions were included. Preoperatively and postoperatively, all surgeons completed a form assessing the expected potential occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF: grade B or C), postoperative hemorrhage, and length of stay. Results: Preoperative intuition was assessed for 101 patients for 52 PD, 44 DP, and 5 CP cases. Overall mortality and morbidity rates were 6.9% (n = 7) and 67.3% (n = 68), respectively, and 38 patients (37.6%) developed a POPF, including 27 (26.7%) CR-POPF. Concordance between preoperative intuition of CR-POPF occurrence and reality was minimal, with a Cohen's kappa coefficient (κ) of 0.175 (P value = 0.009), and the same result was obtained between postoperative intuition and reality (κ = 0.351; P < 0.001). When the pancreatic parenchyma was hard, surgeons predicted the absence of CR-POPF with a negative predictive value of 91.3%. However, they were not able to predict the occurrence of CR-POPF when the pancreas was soft (positive predictive value 48%). Conclusions: This study assessed for the first time the surgeon's intuition in pancreatic surgery, and demonstrated that pancreatic surgeons cannot accurately assess outcomes except when the pancreatic parenchyma is hard.
- Subjects
SURGEONS; PANCREATECTOMY; LONGITUDINAL method; PANCREATIC fistula; PANCREATIC surgery; PANCREATICODUODENECTOMY; LENGTH of stay in hospitals
- Publication
Langenbeck's Archives of Surgery, 2020, Vol 405, Issue 2, p155
- ISSN
1435-2443
- Publication type
Article
- DOI
10.1007/s00423-020-01866-3