Feasibility analysis of predicting the risk of pancreatic fistula after pancreatoduodenectomy by preoperative CT

Abstract

Objective: To study the preoperative computed tomography (CT) data of patients with pancreaticoduodenectomy (PD) and to explore the effective of predicting the risk of postoperative pancreatic fistula (POPF). Methods: CT images of patients with PD were analyzed retrospectively from June 2010 to January 2017 in Zhengzhou University of People's Hospital. The pancreas index, pancreatic duct width, pancreas CT value, pancreas-spleen CT value, and pancreas thickness were collected. The relationship between the indicators and the POPF was determined, and the receiver operation characteristic (ROC) curve was calculated and the area under the curve (AUC) was evaluated. The maximum predictive performance of the critical value was determined by using the different cut-off values to calculate the Youden index and other indicators. Results: A total of 154 patients with PD were involved in the study and 27 (17.5%) had POPF. Seven indicators were significantly associated with POPF. The pancreas index had the largest AUC (AUC: 0.865, P<0.001) and pancreatic duct width (AUC: 0.834, P<0.001) also had a higher predictive value. The pancreatic duct (P<0.001) was significantly associated with POPF. Pancreas thickness, pancreas and spleen CT ratio, abdominal wall fat thickness, pancreas CT value, pancreatic abdominal aorta CT ratio and POPF were also related. Using 0.15 as the cut-off value, the sensitivity, specificity, Jordan index, and accuracy of pancreatic index were 83%, 86%, 0.69, and 0.88 respectively, with the highest performance prediction. Abdominal circumference, spleen CT value and other six indicators had no correlation with POPF. Conclusion: Analysis of preoperative CT indicators of patients can predict the risk of POPF in patients after PD. The pancreas index has the greatest predictive efficacy, while pancreatic duct width, pancreatic spleen density ratio and other indicators also associated with POPF.