Pancreatic Ductal Diameter Changes after Pancreaticoduodenectomy: Impact of Preoperative Factors on Postoperative Imaging

Abstract

Background: Pancreaticoduodenectomy is commonly performed in patients with dilated PD. After resection, it is unclear what should be expected in terms of change of the PD size. Our aim was to compare the change in MPD diameter pre- to postoperatively in patients undergoing pancreaticoduodenectomy. Methods: 85 patients who underwent pancreaticoduodenectomy for IPMN or non-IPMN associated pancreatic adenocarcinoma were examined. Only those patients who had both pre and postoperative images of high quality that could be examined for primary review were included. Two reviewers examined the images in a blinded fashion. Median values with standard deviations were calculated. Results: Patients with IPMN associated carcinomas had larger preoperative PD diameter when compared to those with non-IPMN associated adenocarcinoma (6.28 +/- 3.26 mm vs 5.55 +/- 2.46 mm). In both groups, a decrease in PD diameter was noted (Table 1). However, a larger percent decrease was noted in the patients with IPMN when compared to those without (119% vs 77%). When patients with dilated MPD preoperatively were compared to those with normal ductal caliber, those with dilated ducts experienced a decrease in diameter (-3.44 +/- 2.56 mm) while those with normal ducts were found to have a minimal increase. Conclusions: MPD diameter changes are common after pancreaticoduodenectomy. They are most pronounced in those with IPMN associated cancers and in those with dilated main pancreatic ducts preoperatively. A better understanding of the natural history of postpancreatectomy imaging will help refine diagnostic accuracy in the determination of structural problems postoperatively.Tabled 1EP02D-189Pre-Op MPD Size (mm)Post-op MPD Size (mm)Post-op Δ in MPD (mm)% of patients w/ post-op increase MPD size% of patients w/ post-op decrease in MPD size% of patients w/ no change in post-op MPD sizeIMPN-associated adenocarcinoma6.28 +/- 3.264.42 +/- 2.77-1.86 +/- 4.0510/36 (27.8%) w/ increase by 25%26/36 (72%) w/ decrease by 119%N/AAdenocarcinoma5.55 +/- 2.464.49 +/- 1.75-1.06 +/- 2.513/37 (35%) w/ increase by 26%23/37 (62%) w/ decrease by 77%1/37 (2.7%) w/ no differencePre-Op MPD <6mm3.95 +/- 1.174.13 +/-2.480.19 +/- 2.7524/48 (50%) w/ increase by 25%22/48 (46%) w/ decrease by 78%2/48 (4.2%) w/ no differencePre-Op MPD >6mm8.41 +/- 2.204.96 +/- 1.84-3.44 +/- 2.563/34 (8.8%) w/ increase by 9%31/34 (91%) w/ decrease by 106%N/A Open table in a new tab