BACKGROUND The utility of the proposed alternative fistula risk score (a-FRS) for predicting risk of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) has not been validated widely. METHODS This retrospective analysis included data of patients undergoing open and laparoscopic PD during March 2012-May 2018 in our institution. The predictive abilities of a-FRS and original-FRS were compared. Risk factors for CR-POPF were also evaluated by multivariate regression analysis. RESULTS Of the 370 patients, 80 (21.62%) developed CR-POPF. The incidences of CR-POPF in patients classified as low risk, intermediate risk, and high risk by a-FRS were 5.88%, 24.38%, and 57.69%, respectively (R2 = 0.97). The incidences of CR-POPF in patients classified as negligible risk, low risk, intermediate risk, and high-risk by original-FRS were 0%, 8.62%, 21.51%, and 52.50%, respectively (R2 = 0.92). The area under the ROC curve (AUC) was 0.74 for a-FRS vs. 0.70 for original-FRS. The a-FRS performed better than original-FRS for prediction of CR-POPF in open PD patients (AUC: 0.74 vs. 0.69) and was comparable with original- FRS in laparoscopic PD patients (AUC: 0.70 vs. 0.72). CONCLUSIONS The a-FRS appears to be an accurate and convenient tool for predicting occurrence of CR-POPF after PD.

中文翻译：

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胰十二指肠切除术后预测胰瘘的替代瘘管风险评分（a-FRS）的外部验证。

背景技术提出的替代性瘘管风险评分（a-FRS）用于预测胰十二指肠切除术（PD）后临床相关的术后胰瘘（CR-POPF）风险的实用性尚未得到广泛验证。方法这项回顾性分析包括我们机构在2012年3月至2018年5月期间接受开腹和腹腔镜PD的患者的数据。比较了a-FRS和原始FRS的预测能力。还通过多元回归分析评估了CR-POPF的危险因素。结果在370例患者中，有80例（21.62％）发生了CR-POPF。a-FRS分类为低风险，中风险和高风险的患者中CR-POPF的发生率分别为5.88％，24.38％和57.69％（R2 = 0.97）。CR-POPF在风险可忽略不计，低风险，中度风险，原始FRS的高风险和高风险分别为0％，8.62％，21.51％和52.50％（R2 = 0.92）。a-FRS的ROC曲线下面积（AUC）为0.74，而原始FRS为0.70。在开放性PD患者中，a-FRS预测CR-POPF的效果优于原始FRS（AUC：0.74对0.69），与腹腔镜PD患者的原始FRS相当（AUC：0.70对0.72）。结论a-FRS似乎是预测PD后CR-POPF发生的准确而方便的工具。