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A novel preoperative scoring system to predict postoperative mortality after pancreaticoduodenectomy in pancreatic cancer patients at Dr. Soetomo General Hospital: a retrospective cohort study

  • Arland Chandra ,
  • Tomy Lesmana ,


Introduction: Knowing the risk of surgery before performing one is essential for informed consent and decisions making for the doctors, patients, and their families. Complexities of surgery and pancreatic cancer aggressiveness are two factors that contribute to high mortality rate in pancreaticoduodenectomy. There has been a few scoring systems developed to predict mortality after pancreaticoduodenectomy. However, external validation of these scoring systems failed to achieve good predictive value consistently. This could happen due to differences in patient demographics, variables and their cut-off, patient samples, and hospital or health care standard where these scoring systems were constructed. This study aims to develop a novel scoring system to predict postoperative mortality and to compare its performance with the existing scoring systems.

Methods: Data were collected retrospectively from all patients who underwent pancreaticoduodenectomy in Dr. Soetomo General Hospital, starting from January 2012 to October 2022. 75 patients were included based on the inclusion criteria. Multivariate logistic regression analysis was performed to select multiple risk factors correlated with in-house mortality. A novel scoring system was formed using these risk factors. We also assessed and compared the predictive value of the existing scores (Parikh, Nugroho, and WHipple-ABACUS) using the ROC curve. Chi square test with odds ratio calculation and logistic regression were used in this study.

 Results: Post pancreaticoduodenectomy mortality rate was 28% (21 out of 75 patients) with 4 statistically significant risk factors. Those factors are age > 52 years. (OR 7.435; 95% CI 1.113-49.677, p = 0.038), comorbidities (OR 5.793; 95% CI 1.116-30.067, p = 0.037), American Society of Anaesthesiology (ASA) 3 (OR 8.932; 95% CI 1.329-60.022, p = 0.024), and total bilirubin > 16.6 mg/dL (OR 8.329; 95% CI 1.577-43.983, p = 0,013). These factors were used to form a novel scoring system. The predictive performance of the newly created scoring system was 0.911 (95% CI 0.823-0.965). While external validation of the existing scoring systems was as follows: Parikh 0.684 (95% CI 0.567-9.787), Nugroho 0.829 (95% CI 0.724-0.906), and WHipple-ABACUS 0.736 (95% CI 0.62-0.832).

Conclusion: The newly created scoring system uses 4 relatively easy and accessible preoperative variables to predict post-pancreaticoduodenectomy mortality. However, it still requires external validation in multicenter hospitals with large numbers of patients.


  1. Ntellas P, Dadouli K, Perivoliotis K, et al. Microvessel Density and Impact of Angiogenesis on Survival of Resected Pancreatic Cancer Patients: A Systematic Review and Meta-analysis. Pancreas. 2019;48(2):233-241. doi:10.1097/MPA.0000000000001237
  2. Tjarda Van Heek N, Kuhlmann KFD, Scholten RJ, et al. Hospital volume and mortality after pancreatic resection: A systematic review and an evaluation of intervention in The Netherlands. Ann Surg. 2005;242(6):781-790. doi:10.1097/01.sla.0000188462.00249.36
  3. 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(8):2501-2510. doi:10.1245/s10434-013-2893-x
  4. Parikh P, Shiloach M, Cohen ME, et al. Pancreatectomy risk calculator: An ACS-NSQIP resource. Hpb. 2010;12(7):488-497. doi:10.1111/j.1477-2574.2010.00216.x
  5. Nugroho A, Lalisang TJM. Validation of simplified predictive score for postoperative mortality after pancreaticoduodenectomy. 2014;23(2):87-92.
  6. Gleeson EM, Shaikh MF, Shewokis PA, et al. WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database. Surg (United States). 2016;160(5):1279-1287. doi:10.1016/j.surg.2016.06.040
  7. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: A 20-year experience in 516 patients. Arch Surg. 2004;139(7):718-727. doi:10.1001/archsurg.139.7.718
  8. Panni RZ, Panni UY, Liu J, et al. Re-defining a high volume center for pancreaticoduodenectomy. Hpb. 2021;23(5):733-738. doi:10.1016/j.hpb.2020.09.009
  9. Prospects UN-WP. Indonesia Life Expectancy 1950-2022.
  10. Kimura W, Miyata H, Gotoh M, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: The 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg. 2014;259(4):773-780. doi:10.1097/SLA.0000000000000263
  11. Renaldi K, Fatya AI, Sakinah S. Survival of Pancreatic Cancer Patients in Dr Cipto Mangunkusumo National Referral Hospital Jakarta from November 2018 To December 2018. Indones J Gastroenterol Hepatol Dig Endosc. 2020;20(2):78-81. doi:10.24871/202201978-81
  12. Wahyudi D, Pratiwi SE. Incidence of Pancreatic Cancer Cases in Dr. Soedarso Hospital Pontianak. Indones J Cancer. 2021;15(2):54. doi:10.33371/ijoc.v15i2.722
  13. Paiella S, De Pastena M, Pollini T, et al. Pancreaticoduodenectomy in patients ≥ 75 years of age: Are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center. World J Gastroenterol. 2017;23(17):3077-3083. doi:10.3748/wjg.v23.i17.3077
  14. Hank T, Sandini M, Qadan M, et al. Diabetes mellitus is associated with unfavorable pathologic features, increased postoperative mortality, and worse long-term survival in resected pancreatic cancer. Pancreatology. 2020;20(1):125-131. doi:10.1016/j.pan.2019.10.007
  15. Lim TY, Leitman IM. Risk factors for early morbidity and mortality following pancreatoduodenectomy with concomitant vascular reconstruction. Ann Med Surg. 2021;68(July):102587. doi:10.1016/j.amsu.2021.102587
  16. Larsson P, Feldt K, Holmberg M, et al. Preoperative heart disease and risk for postoperative complications after pancreatoduodenectomy. HPB. 2022;24:1854-1860. doi:10.1016/j.hpb.2022.07.002
  17. Cihoric M, Tengberg LT, Foss NB, Gögenur I, Tolstrup M-B, Bay-Nielsen M. Functional performance and 30-day postoperative mortality after emergency laparotomy—a retrospective, multicenter, observational cohort study of 1084 patients. Perioper Med. 2020;9(1):1-11. doi:10.1186/s13741-020-00143-7
  18. Shen Z, Zhang J, Zhao S, Zhou Y, Wang W, Shen B. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis. Pancreatology. 2020;20(3):529-536. doi:10.1016/j.pan.2020.02.002
  19. Nehme F, Lee JH. Preoperative biliary drainage for pancreatic cancer. Dig Endosc. 2022;34(3):428-438. doi:10.1111/den.14081
  20. Blacker S, Lahiri RP, Phillips M, et al. Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer? Expert Rev Gastroenterol Hepatol. 2021;15(8):855-863. doi:10.1080/17474124.2021.1915127
  21. Sewnath ME, Karsten TM, Prins MH, Rauws EJA, Obertop H, Gouma DJ. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg. 2002;236(1):17-27. doi:10.1097/00000658-200207000-00005

How to Cite

Arland Chandra, & Lesmana, T. (2023). A novel preoperative scoring system to predict postoperative mortality after pancreaticoduodenectomy in pancreatic cancer patients at Dr. Soetomo General Hospital: a retrospective cohort study. Bali Medical Journal, 12(1), 776–781.




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