Estimated pancreatic parenchymal remnant volume accurately predicts clinically relevant pancreatic fistula after pancreatoduodenectomy

Kanda, Mitsuro; Fujii, Tsutomu; Suenaga, Masaya; Takami, Hideki; Hattori, Masashi; Inokawa, Yoshikuni; Yamada, Suguru; Nakayama, Goro; Sugimoto, Hiroyuki; Koike, Masahiko; Nomoto, Shuji; Kodera, Yasuhiro

doi:10.1016/j.surg.2014.04.011

Cited by 39 publications

(36 citation statements)

References 31 publications

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“…A potential correlation between RPV values and the presence of POPF has been well discussed [13, 17, 18]. Frozanpor et al [18] and Kirihara et al [13] reported that RPV values calculated using preoperative MDCT images were a useful predictor of POPF; however, patients with pancreatic head cancer often have atrophic changes in the pancreatic parenchyma and subsequent main pancreatic duct dilation, leading to an overestimation of RPV.…”

Section: Discussionmentioning

confidence: 99%

“…Frozanpor et al [18] and Kirihara et al [13] reported that RPV values calculated using preoperative MDCT images were a useful predictor of POPF; however, patients with pancreatic head cancer often have atrophic changes in the pancreatic parenchyma and subsequent main pancreatic duct dilation, leading to an overestimation of RPV. Moreover, Kanda et al [17] reported that RPV, excluding the remnant volume of the main pancreatic duct, was a better predictor of clinically relevant POPF. However, the RPV values estimated from MDCT images alone are fairly imprecise.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, 3D- measured volumetry is widely used for hepatic resection to facilitate risk prediction as early as the preoperative setting [14-16]. A recent study suggested that a large remnant pancreatic volume (RPV), as estimated using preoperative multidetector computed tomography (MDCT) images, significantly and independently affected the risk of POPF [13, 17, 18]. However, RPV estimated from MDCT was insufficient to simulate the actual pancreatic dissection position and precisely measure RPV.…”

Section: Introductionmentioning

confidence: 99%

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Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Miyamoto

Oshiro

Sano

et al. 2018

Gastrointest Tumors

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Background: Postoperative pancreatic fistula (POPF) is a serious complication that can occur following pancreaticoduodenectomy (PD). Recent studies suggest that remnant pancreatic volume (RPV) values from preoperative multidetector computed tomography (MDCT) are highly predictive of POPF. We performed three-dimensional (3D) surgical simulation of PD including RPV measurements. The aim of this study was to determine whether 3D-measured RPV is predictive of POPF after PD. Methods: We used the SYNAPSE VINCENT® medical imaging system (Fujifilm Medical Co., Ltd., Tokyo, Japan) to construct 3D images after integrating MDCT and magnetic resonance cholangiopancreatography images. RPV was measured using this 3D image, which simulated actual intraoperative pancreatic parenchymal remnant volume. Ninety-one patients who underwent PD were retrospectively enrolled. Using multivariate analysis, RPV and other well-known POPF risk factors were independently assessed. Results: Multivariate analysis identified high RPV values (hazard ratio [HR] = 8.41, p = 0.01), pancreatic duct diameter < 3.0 mm (HR = 5.48, p < 0.01), no pathological fibrosis (HR = 3.41, p < 0.01), and body mass index > 25 kg/m² (HR = 1.53, p = 0.02) as independent risk factors for POPF. Conclusion: The present study indicates that preoperative 3D-measured RPV is predictive of POPF after PD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Miyamoto

Oshiro

Sano

et al. 2018

Gastrointest Tumors

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“…Risk factors for POPF after PD include advanced age [8,9], male gender [6,8,10], obesity and high body mass index [11,12], comorbid cardiovascular diseases [13,14], lack of neoadjuvant chemoradiotherapy [15][16][17] disease pathology [4,8,10,12], soft pancreatic texture [6,8,12,13,18], small pancreatic duct [8,12,18,19], absence of pancreatic parenchymal fibrosis [18,20,21], increased pancreatic fatty infiltration [20,21], large pancreatic remnant volume [22], prolonged operation time [6,10], greater intraoperative blood loss [20], failure to use optical magnification when constructing the pancreatic anastomosis [23,24], and hospital patient volume [25,26].…”

Section: Introductionmentioning

confidence: 99%

Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy

2017

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In performing pancreaticoduodenectomy (PD) or when conducting clinical trials involving PD procedure, a universal platform for predicting the risk of postoperative pancreatic fistula (POPF) is indispensable. In this article, the most significant imaging studies that focused on the objective preoperative assessment of pancreatic pathologies in association with the occurrence of POPF after PD were reviewed. Several recently developed imaging modalities can objectively predict the occurrence of POPF after PD by assessing the elasticity, fibrosis, and fatty infiltration of the pancreas. These valuable imaging modalities include: (1) acoustic radiation force impulse ultrasound (US) electrography which provides information about the elastic properties of the pancreas; (2) contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) with/without contrast-enhancement which reflect the histological degree of pancreatic fibrosis; and (3) multi-detector row CT and/or MRI which reflects the microscopic fatty infiltration of the pancreas. The precise and objective preoperative risk assessment of POPF enables surgeons to customize appropriate management strategies for individual patients undergoing PD. This would be also beneficial for stratifying patients for enrolment in relevant studies that involve pancreatic head resection, as objective criteria could be set for the definitive evaluation of collected data related to surgical outcomes across different institutions and surgeons.

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“…A precise measurement of pancreatic remnant volume using CT scan images has been shown to be useful in predicting POPF before pancreatoduodenectomy [23,24] . However, this measurement needs specific ways of computing (e.g.…”

Section: Introductionmentioning

confidence: 99%

Proposal for a Pancreatic Configuration Index for Determining Patients at High Risk of Pancreatic Fistula Following Pancreatoduodenectomy

Yokoyama

Igami²,

Sugawara³

et al. 2016

Dig Surg

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Background/Aims: The pancreatic configuration is one of the most important factors that have an impact on the incidence of postoperative pancreatic fistula (POPF). This study sought to propose a new index, called the pancreatic configuration index (PCI), to categorize patients at a high risk for POPF. Methods: Two hundred and thirty-one patients who underwent pancreatoduodenectomies were subjected to the analysis. The pancreatic parenchymal thickness and the main pancreatic duct (MPD) diameter at the pancreatic neck were measured using axial computed tomography scan images. The PCI was calculated by dividing the axial thickness by the MPD diameter. Results: Sixty-two of the patients (26.8%) developed clinically significant POPF. Using a receiver operating characteristic curve analysis, the cut-off value of the PCI in predicting POPF was 5.3. The incidence of POFP increased depending on the PCI level. Using a multivariate analysis that included the various risk factors of POPF, a high PIC (≥5) was identified as an independent risk factor of POPF, with the highest OR at 6.50. Conclusion: The PCI is useful for stratifying patients at a high risk for POPFs. This index may be used to classify the patient population when evaluating other risk factors for POPF.

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Estimated pancreatic parenchymal remnant volume accurately predicts clinically relevant pancreatic fistula after pancreatoduodenectomy

Cited by 39 publications

References 31 publications

Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy

Proposal for a Pancreatic Configuration Index for Determining Patients at High Risk of Pancreatic Fistula Following Pancreatoduodenectomy

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