Abstract
BackgroundOur aim is to elucidate the true preoperative risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), making it possible to select POPF high-risk patients preoperatively regardless of intraoperative pancreatic consistency judged by the surgeon’s hand.MethodsAmong the 298 patients who underwent PD with pancreaticojejunostomy from 2007 to 2016, 262 patients had preoperative CT configurations that could be precisely evaluated. Risk factor analyses were conducted using various perioperative factors, including preoperative CT findings, such as CT values of the pancreas, pancreas-visceral fat CT value ratio and pancreatic outer contour. Pancreatic outer contour was further divided into smooth- (smooth interlobular) and serrated-type contours (feathery, irregular interlobular) by preoperative CT.ResultsIn terms of the incidence of POPF, among the 262 patients, POPF grade B/C was found in 27 (10.3%): grade B in 23 (8.8%) and grade C in 4 (1.5%). According to multivariate analysis, a high pancreas-visceral fat CT value ratio (p = 0.002), serrated-type contour (p = 0.02) and no history of chemoradiotherapy (p = 0.019) were identified as independent risk factors for POPF grade B/C. Even in patients with soft pancreas, the incidence of POPF grade B/C was 0% (0/57) in patients with a pancreas-visceral fat CT value ratio of less than − 0.4 and smooth-type contour, whereas the incidence was markedly high (45.0%, 9/20) in patients with a pancreas-visceral fat CT value ratio of − 0.4 or greater and serrated-type contour, indicating that patients with soft pancreas should be categorized into POPF high-risk and low-risk groups according to preoperative CT scan results.ConclusionsThe pancreas-visceral fat CT value ratio and serrated-type pancreas are useful markers to preoperatively identify true POPF high-risk groups in patients undergoing PD, regardless of the pancreatic texture judged intraoperatively.
Highlights
Our aim is to elucidate the true preoperative risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), making it possible to select POPF high-risk patients preoperatively regardless of intraoperative pancreatic consistency judged by the surgeon’s hand
In terms of the treatment of POPF grade B, CTguided drainage was performed in 10 patients, reinitiation of antibiotics in 4, wound drainage in 3, drain exchange in 3, angiography for bleeding in 2 and persistent drainage for more than 3 weeks in one
The analysis revealed that the incidence of POPF grade B/C was markedly high (45.0%, 9/ 20) in patients with a pancreas-visceral fat computed tomography (CT) value ratio of − 0.4 or greater and serrated-type contour, whereas the incidence was 0% (0/57) in patients with a Variables non-POPF, biochemical leakage (BL)
Summary
Our aim is to elucidate the true preoperative risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), making it possible to select POPF high-risk patients preoperatively regardless of intraoperative pancreatic consistency judged by the surgeon’s hand. Despite the fact that a low mortality rate has been observed, the incidence of clinically relevant postoperative pancreatic fistula (POPF: grade B/C), which most negatively affects patient outcome, has been recently reported to be 11–37% in patients with soft pancreas and 1–6% in patients with hard pancreas [4,5,6,7,8,9]. Regarding the risk factors for POPF, previous studies have reported various risk factors, such as age, sex, preoperative jaundice, operative time, intraoperative blood loss, type of pancreatic reconstruction, anastomotic technique, consistency of the pancreatic stump and pancreatic duct diameter [10,11,12,13,14], but there have been no reports focusing on preoperative computed tomography (CT) configurations, especially the contour of the pancreas, for predicting POPF preoperatively. 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 high; the prevention of POPF in patients with soft pancreas is still under discussion [21,22,23]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
