Decision support system for diagnosis of infected pancreatic necrosis

Abstract

s / Pancreatology Unit of General Surgery B, Pancreas Institute, “G.B. Rossi” Hospital, University of Verona Hospital Trust, Italy Background: Pancreatic texture has been identified as one of the most important risk factors for postoperative pancreatic fistula after partial pancreatectomy. Texture definition (classically soft/hard) is however subjective and based on intraoperative gland palpation. Objective: to develop a reproducible method for the assessment of pancreatic texture by using elastic module measurement. Methods: Study population consisted of 140 patients who underwent pancreatic resections at our institution from November 2010 to November 2011. Before pancreatic transection, a calibrated coiled valvewas employed to test pancreatic resistance to compression. Texture was expressed by using pancreatic elastic module (Newton/mm2). Measurements were then correlated with a pathologic score (0-100) based on percentage of fibrosis, pancreatic acini and fat infiltration of the resection margin. Furthermore, the pancreas was palpated by an experienced surgeon (blinded to the elastic module measurement) who subjectively assessed texture on a 1-to10 scale. Results: There was a significant correlation between pancreatic elastic module and pathologic score (p1⁄40.005). In order to define “soft” and “hard” texture, an arbitrary cut off was set at the 75th percentile for pathological score (Total amount of fibrosis >45%). Mean values of elastic modules for soft/hard pancreas did differ significantly (p<0.001), and – surprisingly – surgeon's manual evaluation correlated with both elastic module and pathological assessment. Conclusions: Pancreatic texture can be assessed using elastic module. This is a reproducible method which may represent a common framework for future multicentric studies. The next step of this analysis will be the correlation between pancreatic texture assessed by elastic module and the development of postoperative pancreatic fistula.