LAUSR

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.