Computed tomography attenuation and patient characteristics as predictors of complications after pancreaticoduodenectomy

Abstract

Objectives: Morbidity after pancreaticoduodenectomy (PD) remains high. Computed tomography (CT) of intra-abdominal tissue has not been thoroughly evaluated to establish associations with the occurrence of complications after PD. The current study sought to determine whether differences in non-enhanced visceral attenuation predicted complications after PD.

Methods: Outcomes in patients undergoing PD were analysed according to the Clavien system for classifying complications and the International Study Group on Pancreatic Fistula system for classifying postoperative pancreatic fistula (POPF). Preoperative non-enhanced CT scans were evaluated by a blinded investigator for attenuation of abdominal viscera and fat thickness. Data on pancreatic firmness and pancreatic duct size were collected. Univariate and multivariate analyses were performed.

Results: A total of 134 patients underwent PD for malignant and benign disease. Rates of morbidity, mortality and POPF at 90 days were 61%, 4% and 23%, respectively. Patients with a body mass index of > 25 kg/m(2) had higher rates of POPF (P = 0.05) and complications (P < 0.01). In multivariate analysis, patients were more likely to develop any complication as CT attenuation decreased for paraspinus muscle (P < 0.01), spleen (P < 0.03) and liver (P = 0.01) parenchyma.

Conclusions: Postoperative complications after PD remain prevalent. Decreased CT attenuation of abdominal viscera is an independent predictor of morbidity after PD and suggests a high-risk patient physiology for pancreatic resection.

Figure 1

Examples of preoperative computed tomography (CT) attenuation and fat thickness measurements. Axial non-enhanced preoperative CT is evaluated for pancreaticoduodenectomy for treatment of a duodenal carcinoma. (a) Regions of interest with associated attenuation values in Hounsfield units (HU) of the pancreas, spleen, liver and paraspinus muscle. (b) Measurement of periumbilical fat thickness in mm. (c) Measurement of hip girdle fat thickness in mm. (d) Measurement of retrorenal fat thickness in mm