Predicting Postoperative Pancreatic Fistula after Distal Pancreatectomy by Measuring the CT Value Ratio of Future Pancreas Remnant to Spleen (P/S Ratio) in Preoperative Unenhanced CT Images

Mori, Nobuhiro; Sakurai, Naoki; Iizawa, Hajime

doi:10.5833/jjgs.2017.0181

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…Rather, the pancreatic parenchymal CT value was significantly higher in the CR-POPF group, indicating that pancreas fat deposition in this group might be milder than in the non POPF/BL group. Furthermore, an investigation on POPF after DP by Mori et al [ 15 ] indicated that patients with a high pancreatic parenchymal CT value or P/S ratio had mild pancreatic fat deposition and maintained pancreatic exocrine function, and showed a significantly higher POPF incidence than those who do not; these results are similar to the findings of the present study. It is clear that a soft pancreas is a risk factor for POPF after PD, but whether it is a risk factor for POPF after DP, is still controversial [ 21 , 33 , 34 ].…”

Section: Discussionsupporting

confidence: 91%

“…Although most of these factors can be evaluated preoperatively, pancreatic texture can be determined only by intraoperative findings. Recently, fat deposition in pancreatic parenchyma—related to soft pancreas—has been reported to be strongly associated with POPF after PD, and it is represented by a low pancreatic parenchymal CT value [ 14 , 15 ]. In addition, preoperative CT images have reportedly been useful in hepatobiliary and pancreatic surgery [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

et al. 2022

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Background In pancreaticoduodenectomy, the pancreas-visceral fat CT value ratio and serrated pancreatic contour on preoperative CT have been revealed as risk factors for postoperative pancreatic fistulas. We aimed to evaluate whether they could also serve as risk factors for postoperative pancreatic fistulas after distal pancreatectomy. Methods A total of 251 patients that underwent distal pancreatectomy at our department from 2006 to 2020 were enrolled for the study. We retrospectively analyzed risk factors for postoperative pancreatic fistulas after distal pancreatectomy using various pre and intraoperative factors, including preoperative CT findings, such as pancreas-visceral fat CT value ratio and serrated pancreatic contour. Results The study population included 147 male and 104 female participants (median age, 68 years; median body mass index, 21.4 kg/m2), including 64 patients with diabetes mellitus (25.5%). Preoperative CT evaluation showed a serrated pancreatic contour in 80 patients (31.9%), a pancreatic thickness of 9.3 mm (4.0–22.0 mm), pancreatic parenchymal CT value of 41.8 HU (4.3–22.0 HU), and pancreas-visceral fat CT value ratio of − 0.41 (− 4.88 to − 0.04). Postoperative pancreatic fistulas were developed in 34.2% of the patients. Univariate analysis of risk factors for postoperative pancreatic fistulas showed that younger age (P = 0.005), high body mass index (P = 0.001), absence of diabetes mellitus (P = 0.002), high preoperative C-reactive protein level (P = 0.024), pancreatic thickness (P < 0.001), and high pancreatic parenchymal CT value (P = 0.018) were significant risk factors; however, pancreas-visceral fat CT value ratio (P = 0.337) and a serrated pancreatic contour (P = 0.122) did not serve as risk factors. Multivariate analysis showed that high body mass index (P = 0.032), absence of diabetes mellitus (P = 0.001), and pancreatic thickness (P < 0.001) were independent risk factors. Conclusion The pancreas-visceral fat CT value ratio and serrated pancreatic contour evaluated using preoperative CT were not risk factors for postoperative pancreatic fistulas after distal pancreatectomy. High body mass index, absence of diabetes mellitus, and pancreatic thickness were independent risk factors, and a close-to-normal pancreas with minimal fat deposition or atrophy is thought to indicate a higher risk of postoperative pancreatic fistulas after distal pancreatectomy.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Rather, the pancreatic parenchymal CT value was signi cantly higher in the CR-POPF group, indicating that pancreas fat depositionin this group might be milder than in the non POPF/BL group. Furthermore, an investigation on POPF after DP by Mori et al [7]indicated that patients with a high pancreatic parenchymal CT value or P/S ratio had mild pancreatic fat deposition and maintained pancreatic exocrine function, and showeda signi cantly higher POPF incidence than those who do not; these results are similar to the ndingsof the present study. It is clear that a soft pancreas is a risk factor for POPF after PD, but whether it is a risk factor for POPF after DP, is still controversial [8, [20][21][22].…”

Section: Discussionsupporting

confidence: 91%

“…Althoughmost of these factors can beevaluated preoperatively, pancreatictexturecan be determined only by intraoperative ndings. Recently,fat depositioninpancreaticparenchyma-related to soft pancreas-has been reported tobe strongly associated with POPF after PD, and it is represented by alow pancreatic parenchymal CT value [6,7]. In this regard, we have recently reportedthat the pancreas-visceral fat CT value ratio (PVFR) and serrated pancreatic contour,which can be obtained by preoperative CT images,were associated with fat deposition of the pancreatic parenchyma, and thatthese factors were selected as strong risk factors of POPF after PD [8].…”

Section: Introductionmentioning

confidence: 99%

Risk Factor Analysis of Postoperative Pancreatic Fistula After Distal Pancreatectomy, with A Focus on Pancreas-Visceral Fat CT Value Ratio and Serrated Pancreatic Contour, Evaluated Using Preoperative CT Images: A Retrospective Single Center Study

Maeda

Kuriyama

Yuge

et al. 2022

Preprint

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Background: In pancreaticoduodenectomy, the pancreas-visceral fat CT value ratio and serrated pancreatic contour on preoperative CT have been revealed as risk factors for postoperative pancreatic fistulas. We aimed to evaluate whether they could also serve as risk factors for postoperative pancreatic fistulas after distal pancreatectomy. Methods: A total of 251 patients that underwent distal pancreatectomy at our department from 2006 to 2020 were enrolled for the study. We retrospectively analyzed risk factors for postoperative pancreatic fistulas after distal pancreatectomy using various pre and intraoperative factors, including preoperative CT findings, such as pancreas-visceral fat CT value ratio and serrated pancreatic contour. Results: The study population included 147 male and 104 female participants (median age, 68 years; median body mass index, 21.4 kg/m2), including 64 patients with diabetes mellitus (25.5%). Preoperative CT evaluation showed a serrated pancreatic contour in 80 patients (31.9%), a pancreatic thickness of 9.3 mm (4.0–22.0 mm), pancreatic parenchymal CT value of 41.8 HU (4.3–22.0 HU), and pancreas-visceral fat CT value ratio of -0.41 (-4.88 to -0.04). Postoperative pancreatic fistulas were developed in 34.2% of the patients. Univariate analysis of risk factors for postoperative pancreatic fistulas showed that younger age (P = 0.005), high body mass index (P = 0.001), absence of diabetes mellitus (P = 0.002), high preoperative C-reactive protein level (P = 0.024), pancreatic thickness (P < 0.001), and high pancreatic parenchymal CT value (P = 0.018) were significant risk factors; however, pancreas-visceral fat CT value ratio (P = 0.337) and a serrated pancreatic contour (P = 0.122) did not serve as risk factors. Multivariate analysis showed that high body mass index (P = 0.032), absence of diabetes mellitus (P = 0.001), and pancreatic thickness (P < 0.001) were independent risk factors. Conclusion: The pancreas-visceral fat CT value ratio and serrated pancreatic contour evaluated using preoperative CT were not risk factors for postoperative pancreatic fistulas after distal pancreatectomy. High body mass index, absence of diabetes mellitus, and pancreatic thickness were independent risk factors, and a close-to-normal pancreas with minimal fat deposition or atrophy is thought to indicate a higher risk of postoperative pancreatic fistulas after distal pancreatectomy.

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“…With the advancement of imaging tests, such as echocardiography, CT, and MRI, fatty pancreas has become relatively easy to diagnose. A decrease in the pancreatic CT value on plain abdominal CT images correlates with the degree of pancreatic fatty infiltration ( Kim et al, 2014 ; Mori et al, 2019 ). In histological evaluation of fatty pancreas, when the ratio of pancreatic CT value/splenic CT value is less than 0.8, moderate or more fatty deposits are observed in the pancreatic parenchyma ( Mori et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for fatty pancreas and effects of fatty infiltration on pancreatic cancer

Otsuka,

Shimizu,

Taniai

et al. 2023

Front. Physiol.

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Objective: This study clarified the risk factors and pathophysiology of pancreatic cancer by examining the factors associated with fatty pancreas.Methods: The degree of fatty pancreas, background factors, and incidence of pancreatic cancer were examined among nonalcoholic fatty liver disease (NAFLD) patients (n = 281) and intraductal papillary mucinous neoplasm (IPMN) patients with a family history of pancreatic cancer (n = 38). The presence of fatty pancreas was confirmed by the pancreatic CT value/splenic CT value ratio (P/S ratio). Immunohistochemical staining was performed on 10 cases with fatty pancreas, confirmed via postoperative pathology.Results: Fatty pancreas occurred in 126 patients (44.8%) in the NAFLD group who were older (p = 0.0002) and more likely to have hypertension (p < 0.0001). The IPMN group had 18 patients (47.4%) with fatty pancreas, included more men than women (p = 0.0056), and was more likely to have patients with hypertension (p = 0.0010). On histological examination, a significant infiltration of adipocytes into the acini from the pancreatic interstitium induced atrophy of the pancreatic parenchyma, and both M1 and M2 macrophages were detected in the area where adipocytes invaded the pancreatic parenchyma. Accumulation of p62 and increased positive staining of NQO1 molecules related to autophagy dysfunction were detected in pancreatic acinar cells in the fatty area, acinar-ductal metaplasia, and pancreatic cancer cells. The rate of p62-positive cell area and that of NQO1-positive cell area were significantly higher in the fatty pancreatic region than those in the control lesion (pancreatic region with few adipocyte infiltration). Furthermore, the rate of p62-positive cell area or that of NQO1-positive cell area showed strong positive correlations with the rate of fatty pancreatic lesion. These results suggest that adipocyte invasion into the pancreatic parenthyme induced macrophage infiltration and autophagy substrate p62 accumulation. High levels of NQO1 expression in the fatty area may be dependent on p62 accumulation.Conclusion: Hypertension was a significant risk factor for fatty pancreas in patients with NAFLD and IPMN. In fatty pancreas, fatty infiltration into the pancreatic parenchyme might induce autophagy dysfunction, resulting in activation of antioxidant proteins NQO1. Thus, patients with fatty pancreas require careful follow-up.

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Predicting Postoperative Pancreatic Fistula after Distal Pancreatectomy by Measuring the CT Value Ratio of Future Pancreas Remnant to Spleen (P/S Ratio) in Preoperative Unenhanced CT Images

Cited by 3 publications

References 14 publications

Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

Risk Factor Analysis of Postoperative Pancreatic Fistula After Distal Pancreatectomy, with A Focus on Pancreas-Visceral Fat CT Value Ratio and Serrated Pancreatic Contour, Evaluated Using Preoperative CT Images: A Retrospective Single Center Study

Risk factors for fatty pancreas and effects of fatty infiltration on pancreatic cancer

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