Characteristics of postoperative pancreatic fistula on abdominal CT: a multicenter cohort study

Abstract

Introduction: Pancreatic fistula is a potentially severe complication after pancreatic resection. Our aim was to describe the characteristics of clinically relevant postoperative pancreatic fistula on abdominal imaging Methods: Consecutive patients undergoing computed tomography (CT) scan for (suspected) pancreatic fistula after pancreatoduodenectomy in 2015–2016 in 4 centres of the Dutch Pancreatic Cancer Group were included. Scans were systematically re-evaluated by two expert radiologists according to a predefined form. Scans were considered positive for clinically relevant pancreatic fistula when followed by an invasive intervention for pancreatic fistula, an intensive care unit admission or death due to abdominal sepsis. Results: This preliminary analysis included outcomes of 213 scans performed in 150 patients: 72 scans were positive and 141 scans were negative for clinically relevant pancreatic fistula. The pancreatic anastomosis was dehiscent in 38/72 positive and 51/141 negative scans (53% vs. 36%; P=0,03; positive predictive value [PPV]0.42, negative predictive value [NPV]0.72). Fluid in direct contact to the pancreatic anastomosis was seen in 57/72 positive and 94/141 negative scans (80% vs. 67%; P=0.06; PPV0.38; NPV0.76), these collections contained gas in 40/57 positive and 52/94 negative scans (70% vs. 55%; P=0.10; PPV0.43; NPV0.70). Conclusion: Characteristics of clinically relevant pancreatic fistula after pancreatoduodenectomy include dehiscence of the pancreatic anastomosis and fluid in direct contact to the anastomosis containing gas, although diagnostic accuracy of these individual variables is low. Further analysis will be focused on combining radiological and clinical data to ultimately create a model for early identification of patients with clinically relevant postoperative pancreatic fistula.