title: External assessment of the Early Mortality Risk Score in patients with adenocarcinoma undergoing pancreaticoduodenectomy.
abstract: BACKGROUND
  Pancreaticoduodenectomies (PD) still have a substantial mortality rate. Recently, different scores have been published to predict the mortality risk pre-operatively after PD. This retrospective study was designed to perform an external assessment of an Early Mortality Risk Score (EMRS).
  
  
  METHODS
  From 2000 to 2012, all PD cases performed at our institution were documented. Only patients treated for pancreatic head adenocarcinomas were included. Survival time and EMRS (based on age, tumour size, tumour differentiation and comorbidities) were calculated for every patient. Relative risks (RR) of early death 9 and 12 months after PD were then calculated.
  
  
  RESULTS
  Of 270 PD for various aetiologies, 120 PD for adenocarcinomas were included. The median follow-up was 37 months, and the overall median survival was 19 months. EMRS of 4 showed a mortality RR of 5.1 at 9 months (P = 0.048) and of 4.5 at 12 months (P = 0.020).
  
  
  CONCLUSIONS
  EMRS of 4 is a predictor of tumour-related mortality at 9 and 12 months after PD for adenocarcinoma. The EMRS was externally assessed in our patient cohort and can be implemented in clinical practice. Clinical implications of this score still need to be studied.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Gaëtan-Romain
authors.initials: GR
authors.lastname: Joliat
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Petermann
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D002454:Cell Differentiation; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden