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. 2017 May 11;12(5):e0177052.
doi: 10.1371/journal.pone.0177052. eCollection 2017.

Prediction of pancreatic fistula after pancreatoduodenectomy by preoperative dynamic CT and fecal elastase-1 levels

Jung-Hyun Kang  1 , Joon Seong Park  2 , Jeong-Sik Yu  1 , Jae-Joon Chung  1 , Joo Hee Kim  1 , Eun-Suk Cho  1 , Dong Sup Yoon  2
Affiliations

Prediction of pancreatic fistula after pancreatoduodenectomy by preoperative dynamic CT and fecal elastase-1 levels

Jung-Hyun Kang et al. PLoS One. .

Abstract

Objective: To validate preoperative dynamic CT and fecal elastase-1 level in predicting the development of pancreatic fistulae after pancreatoduodenectomy.

Materials and methods: For 146 consecutive patients, CT attenuation values of the nontumorous pancreatic parenchyma were retrospectively measured on precontrast, arterial and equilibrium phase images for calculation of enhancement ratios. CT enhancement ratios and preoperative fecal elastase-1 levels were correlated with the development of pancreatic fistulae using independent t-test, logistic regression models, ROC analysis, Youden method and tree analysis.

Results: The mean value of enhancement ratio on equilibrium phase was significantly higher (p = 0.001) in the patients without pancreatic fistula (n = 107; 2.26±3.63) than in the patients with pancreatic fistula (n = 39; 1.04±0.51); in the logistic regression analyses, it was significant predictor for the development of pancreatic fistulae (odds ratio = 0.243, p = 0.002). The mean preoperative fecal elastase-1 levels were higher (odds ratio = 1.003, p = 0.034) in the pancreatic fistula patients than other patients, but there were no significant differences in the areas under the curve between the prediction values of CT enhancement ratios and fecal elastase-1 combined and those of CT enhancement ratios alone (P = 0.897, p = 0.917) on ROC curve analysis. Tree analysis revealed that the CT enhancement ratio was more powerful predictor of pancreatic fistula than fecal elastase-1 levels.

Conclusion: The preoperative CT enhancement ratio of pancreas acquired at equilibrium phase regardless of combination with fecal elastase-1 levels might be a useful predictor of the risk of developing a pancreatic fistula following pancreatoduodenectomy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Measurement of pancreatic parenchymal attenuation density with ROI (region of interest).
A, B. Comparing to normal pancreatic parenchyma (A), fibrotic pancreas (B) shows gradually increased and higher attenuation densities at the same ROI. Pre, pre-contrast; AP, arterial phase; EP, equilibrium phase.
Fig 2
Fig 2. Receiver operating characteristic (ROC) curve of the CT attenuation ratios.
Pre, pre-contrast; AP, arterial phase; EP, equilibrium phase.
Fig 3
Fig 3. ROC curve of the fecal elastase-1 levels.
Fig 4
Fig 4. ROC curve for the comparison of the fecal elastase-1 levels at the cut-off points of 120.1μg/g stool and 200 μg/g stool.
Fig 5
Fig 5. ROC curve for the comparison of the abilities of the CT enhancement ratios alone and the combination of CT enhancement ratios and fecal elastase-1 levels to predict postoperative pancreatic fistulae.
Pre, pre-contrast; AP, arterial phase; EP, equilibrium phase.
Fig 6
Fig 6. Tree analysis of the abilities of the CT enhancement ratios and fecal elastase-1 levels to predict postoperative pancreatic fistulae.
Pre, pre-contrast; AP, arterial phase; EP, equilibrium phase.
See this image and copyright information in PMC

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