The effect of atrophied pancreas as shown in the preoperative imaging on the leakage rate after pancreaticoduodenectomy

Abstract

Backgrounds/Aims The soft texture of the pancreas parenchyma may influence the incidence of pancreatic leakage after pancreaticoduodenectomy (PD). One possible method to assess pancreatic texture and atrophy, is via computed tomography (CT) scan of the abdomen. The purpose of our study was to evaluate the relation between the preoperative CT scan and the incidence of pancreatic fistula after PD. Methods A retrospective single-center study including patients who underwent PD for a benign and malignant tumor of the periampullary region between the years 2000 and 2016. Demographic and imaging data were analysed and a correlation with the post-operative leak was evaluated. Results Pancreatic leak was documented in 34 out of 154 (22.1%) patients. All the leakage cases occurred in the preserved pancreas group (33.1% of the total preserved pancreas group alone). No leak was documented in the atrophic pancreas group. This difference between the two groups was found to be statistically significant (p ≤ 0.00001). Conclusions Atrophic pancreas in the preoperative CT scan may be protective against leakage after PD. These findings may help the surgeon to risk stratify patients accordingly. In addition, the findings suggest that patients with a preserved pancreas may require more protective methods to prevent leakage.

Identifying the risk factors for pancreatic fistula after laparoscopic pancreaticoduodenectomy in patients with pancreatic cancer

“…The soft texture of the pancreas has better exocrine function and can secrete more trypsinogen than the normal pancreatic texture[ 18 ]. The soft pancreas in matches is easy to tear and suture, causing pancreatic leakage and corrosion of surrounding tissue and blood vessels, inducing and aggravating postoperative PFs[ 19 , 20 ]. However, the hardness of the pancreas can only be subjectively evaluated by observing its morphology under laparoscopy because of the lack of direct contact with the pancreas during LPD; therefore, its texture accuracy needs to be investigated owing to the lack of standardized criteria for assessing the softness and hardness of the pancreas.…”