Pancreas-visceral fat CT value ratio and serrated pancreatic contour are strong predictors of postoperative pancreatic fistula after pancreaticojejunostomy

Abstract

Background: Our aim is to elucidate the true preoperative risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), making it possible to select POPF high-risk patients preoperatively regardless of intraoperative pancreatic consistency judged by the surgeon's hand. Methods: Among the 298 patients who underwent PD with pancreaticojejunostomy from 2007 to 2016, 262 patients had preoperative CT configurations that could be precisely evaluated. Risk factor analyses were conducted using various perioperative factors, including preoperative CT findings, such as CT values of the pancreas, pancreasvisceral fat CT value ratio and pancreatic outer contour. Pancreatic outer contour was further divided into smooth-(smooth interlobular) and serrated-type contours (feathery, irregular interlobular) by preoperative CT. Results: In terms of the incidence of POPF, among the 262 patients, POPF grade B/C was found in 27 (10.3%): grade B in 23 (8.8%) and grade C in 4 (1.5%). According to multivariate analysis, a high pancreas-visceral fat CT value ratio (p = 0.002), serrated-type contour (p = 0.02) and no history of chemoradiotherapy (p = 0.019) were identified as independent risk factors for POPF grade B/C. Even in patients with soft pancreas, the incidence of POPF grade B/C was 0% (0/57) in patients with a pancreas-visceral fat CT value ratio of less than − 0.4 and smooth-type contour, whereas the incidence was markedly high (45.0%, 9/20) in patients with a pancreas-visceral fat CT value ratio of − 0.4 or greater and serrated-type contour, indicating that patients with soft pancreas should be categorized into POPF high-risk and low-risk groups according to preoperative CT scan results. Conclusions: The pancreas-visceral fat CT value ratio and serrated-type pancreas are useful markers to preoperatively identify true POPF high-risk groups in patients undergoing PD, regardless of the pancreatic texture judged intraoperatively.

Preoperative Computed Tomography Imaging of the Pancreas Identifying Predictive Factors for the Progression of Grade A, or Biochemical Leak, to Grade B Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: A Retrospective Study

“…In recent years, some studies have confirmed that that preoperative CT scans have the value of predicting POPF [ 21 , 22 ], and some research suggested that the number of CT scans of the pancreas was related to the density of the pancreas and suggested pancreatic fibrosis [ 23 , 24 ]. In addition, Kusafuka et al reported that a pancreas-visceral fat CT value ratio ≥ – 0.40 and a serrated-type pancreas might indicate a high risk of POPF [ 14 ]. To standardize the judgement of pancreatic texture, the preoperative plain CT scan was chosen as the index in this study.…”

“…Some research groups have extensively analyzed CT images of the pancreas and have identified many variables that are significantly associated with POPF [ 12 – 14 ]. The diameter of the main pancreatic duct (MPD) and the CT value of the pancreatic body are the independent components derived from CT images.…”

“…More attention should be given to the possibility of patients with biochemical leaks progressing to grade B pancreatic fistula after surgery [ 11 ]. Some researchers suggested that data from computed tomography (CT) imaging before surgery might provide useful information about the risk of POPF [ 12 – 14 ]. Therefore, in this retrospective study, we aimed to identify the predictive factors for the progression of grade A, or early biochemical leak, to grade B postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy using preoperative CT imaging of the pancreas.…”

The usefulness of preoperative exocrine function evaluated by the 13C-trioctanoin breath test as a significant physiological predictor of pancreatic fistula after pancreaticoduodenectomy

“…The 30-day and in-hospital mortality rates were reported to be 1.2% and 2.8%, respectively, according to Japan's National Clinical Database [1]. However, postoperative pancreatic fistula (PF) is still a significant threat to both patients and pancreatic surgeons because it sometimes causes fatal postoperative intra-abdominal bleeding [2,3] and abscess [4,5], and its incidence is still reported to be high (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29).4%) in patients with soft pancreas [6][7][8]. Therefore, there is a need to elucidate the global preoperative risk factors for PF, and several studies have shown preoperative risk factors such as obesity, fatty pancreas, narrow pancreatic duct, male sex, and surgical techniques [9][10][11].…”

Favorable Preoperative Exocrine Function Evaluated by 13C Trioctanoin Breath Test is a Significant Physiological Predictor of Pancreatic Fistula After Pancreaticoduodenectomy

“…30-day and in-hospital mortality rates were reported to be 1.2 and 2.8%, respectively, by national clinical database from Japan 1 . However, postoperative pancreatic stula (PF) is still a large threat to both patients and pancreatic surgeons, because it sometimes causes the postoperative fatal intraabdominal bleeding 2, 3 and abscess 4,5 , and its incidence is still reported to be high (11-29.4%) in patients with soft pancreas [6][7][8] . Therefore, it is urgent to elucidate the global preoperative risk factor of PF and there has been several articles showing the preoperative risk factors such as obesity, fatty pancreas, narrow pancreatic duct, male and surgical technics et al [9][10][11] .…”