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

Abstract

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.

Does Braun Anastomosis Have an Impact on the Incidence of Delayed Gastric Emptying and the Extent of Intragastric Bile Reflux Following Pancreatoduodenectomy? - A Randomized Controlled Study

“…In contrast, the incidence of DGE was significantly associated with the incidence of pancreatic fistula, which is a well-recognized risk factor of DGE [11,19] . The incidence of DGE was also associated with the small main pancreatic duct diameter, which is a major risk factor for pancreatic fistula [20] . Hocking et al [21] previously reported that peripancreatic inflammation may result in gastric dysrhythmia, which may explain one of the mechanisms of DGE.…”

Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy

“…The precise preoperative evaluation of PF occurrence enables surgeons to customize or modify perioperative management including operator selection, the placement of feeding jejunostomy tube/external pancreatic duct stenting, additional peritoneal drain insertion, or resumption of an oral diet schedule. These measures may reduce the occurrence of PF .…”

“…All patients underwent subtotal stomach‐preserving pancreatoduodenectomy (SSPPD) or pylorus‐preserving pancreatoduodenectomy (PPPD). Pancreatojejunostomies were performed using the duct‐to‐mucosa method or invagination . PF was diagnosed and graded in accordance with the International Study Group on Pancreatic Fistula (ISGPF) definition and classifications , and grade B fistula (fistula requiring any therapeutic intervention) or higher was regarded as clinically significant.…”

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

“…Our institution reported the method of 12 interrupted-stitched duct-to-mucosa pancreaticojejunostomy, named the "pair-watch suturing technique (PWST)", which allowed us to standardize the method of pancreaticojejunostomy [18][19][20]. However, even though the anastomotic technique has progressed, POPF still has yet to be thoroughly prevented after PD, and the incidence of POPF in patients with soft pancreas has been reported to be particularly high; thus, the prevention of POPF in patients with soft pancreas is still under discussion [21][22][23].…”