Nomogram to predict late extraluminal postpancreatectomy hemorrhage in patients with postoperative pancreatic fistula after pancreaticoduodenectomy

Background: Late extraluminal postpancreatectomy hemorrhage (LEPPH) is a rare but severe complication of pancreaticoduodenectomy (PD). Current predictors of LEPPH are limited and cannot quantify bleeding risk. As a consequence, establishment of a prediction model of LEPPH is important. This study aims to construct a nomogram combining perioperative factors to predict LEPPH. Methods: A total of 2,924 retrospective and 467 prospective cases undergoing PD, 420 retrospective cases and 131 prospective cases with postoperative pancreatic fistula (POPF) after PD from three centers were included. Three hundred and seventy-one retrospective cases from West China Hospital were divided randomly into the development cohort (n=259) and the internal validation cohort (n=112). Another 180 patients consisting of 49 retrospective and 131 prospective cases from three pancreatic centers were enrolled as the external validation set. A nomogram was established based on the independent risk factors. sign, pancreaticoenteric anastomotic cracking (PEAC), surgery-related acute pancreatitis (AP), and positive culture in intra-abdominal drainage fluid as independent risk factors of LEPPH. Combined with those variables, the nomogram showed reliable C-index of 0.932, 0.924 and 0.954 in predicting LEPPH in the three cohorts respectively. Conclusions: The nomogram exhibited excellent predictive capabilities for LEPPH after PD. It could aid surgeons in early identification of patients prone to LEPPH following PD, enabling timely interventions and improving patient survival.