Simple Preoperative Imaging Measurements Predict Postoperative Pancreatic Fistula After Pancreatoduodenectomy

Objective Postoperative pancreatic fistula is a potentially devastating complication after pancreatoduodenectomy (PD). The purpose of this study was to identify features on preoperative computed tomography (CT) imaging that correlate with an increased risk of postoperative pancreatic fistula (POPF)....

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Bibliographic Details
Published in:Annals of surgical oncology 2024-03, Vol.31 (3), p.1898-1905
Main Authors: Sok, Caitlin, Sandhu, Sameer, Shah, Hardik, Ajay, Pranay S., Russell, Maria C., Cardona, Kenneth, Maegawa, Felipe, Maithel, Shishir K., Sarmiento, Juan, Goyal, Subir, Kooby, David A., Shah, Mihir M.
Format: Article
Language:English
Subjects:
Abdomen
Abdominal wall
Complications
Computed tomography
Fistula
Fistulae
Humans
Medicine
Medicine & Public Health
Oncology
Pancreas
Pancreas - surgery
Pancreatic Ducts - surgery
Pancreatic Fistula - etiology
Pancreatic Tumors
Pancreaticoduodenectomy
Pancreaticoduodenectomy - adverse effects
Patients
Peritoneum
Postoperative
Postoperative Complications - etiology
Retrospective Studies
Risk Factors
Surgery
Surgical Oncology
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Summary:Objective Postoperative pancreatic fistula is a potentially devastating complication after pancreatoduodenectomy (PD). The purpose of this study was to identify features on preoperative computed tomography (CT) imaging that correlate with an increased risk of postoperative pancreatic fistula (POPF). Methods Patients who underwent PD at our high-volume pancreatic surgery center from 2019 to 2021 were included if CT imaging was available within 8 weeks of surgical intervention. Pancreatic neck thickness (PNT), abdominal wall thickness (AWT), and intra-abdominal distance from pancreas to peritoneum (PTP) were measured by two board-certified radiologists who were blinded to the clinical outcomes. Radiographic measurements, as well as preoperative patient characteristics and intraoperative data, were assessed with univariate and multivariable analysis (MVA) to determine risk for clinically relevant POPF (CR-POPF, grades B and C). Results A total of 204 patients met inclusion criteria. Median PTP was 5.8 cm, AWT 1.9 cm, and PNT 1.3 cm. CR-POPF occurred in 33 of 204 (16.2%) patients. MVA revealed PTP > 5.8 cm (odds ratio [OR] 2.86, p = 0.023), PNT > 1.3 cm (OR 2.43, p = 0.047), soft pancreas consistency (OR 3.47, p = 0.012), and pancreatic duct size ≤ 3.0 mm (OR 4.55, p = 0.01) as independent risk factors for CR-POPF after PD. AWT and obesity were not associated with increased risk of CR-POPF. Patients with PTP > 5.8 cm or PNT > 1.3 cm were significantly more likely to suffer a major complication after PD (39.6% vs. 22.3% and 40% vs. 22.1%, p 
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-023-14564-3