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Observational Study
. 2022 Sep;407(6):2363-2372.
doi: 10.1007/s00423-022-02564-y. Epub 2022 May 28.

Development of a prediction model of pancreatic fistula after duodenopancreatectomy and soft pancreas by assessing the preoperative image

Rocío Maqueda González  1 , Marcello Di Martino  2   3 , Itxaso Galán González  4   5 , Pablo Rodríguez Carnero  4 , Elena Martín-Pérez  2
Affiliations
Observational Study

Development of a prediction model of pancreatic fistula after duodenopancreatectomy and soft pancreas by assessing the preoperative image

Rocío Maqueda González et al. Langenbecks Arch Surg. 2022 Sep.

Abstract

Background: Pancreatic consistency is one of the most widely accepted risk factors of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatectoduodenectomy (PD). The present study aims to identify preoperative characteristics from the preoperative computed tomography (CT) associated with an increased risk.

Methods: Retrospective observational cohort study of patients who underwent PD surgery (January 2010-2019) were enrolled. All patients with available preoperative imaging were included; 103 met the inclusion criteria. Several parameters were measured on preoperative abdominal CT: retrorenal adipose tissue; abdominal perimeter; total adipose tissue, visceral and subcutaneous; skeletal muscle mass; main pancreatic duct (MPD) diameter; pancreatic thickness; remnant pancreatic volume; pancreatic attenuation (pancreas-to-spleen ratio). Primary endpoints were the association of radiological variables with soft pancreatic consistency and POPF development. All variables possibly associated with POPF and soft pancreas were subsequently included into a multivariable logistic regression model.

Results: Soft pancreas consistency was found in 43 patients (41.7%) and CR-POPF was higher (51.2% vs. 18%, p < 0.001). Multivariable analysis identified MPD ≤ 3 mm (OR = 7.2, 95%CI 2.3-23, p = 0.001), a remnant pancreatic volume ≥ 20 cm3 (OR = 6.4, 95%CI 2-21, p = 0.041), pancreas-to-spleen < 0.8 (OR = 3.2, 95%CI 1.2-8.4, p = 0.039), and retrorenal adipose tissue ≥ 12 cm3 (OR = 5.3, 95%CI 1.8-15.7, p = 0.013). Multivariable analysis showed MPD ≤ 3 mm (OR = 8.25, 95%CI 2.2-30.8, p = 0.002) and total adipose tissue ≥ 190 cm3 (OR = 3.2, 95%CI 1.1-9.1, p = 0.0027) were independent predictors of CR-POPF.

Conclusion: The preoperative assessment of MPD, remnant pancreatic volume, pancreas-to-spleen ratio, total adipose tissue, and retrorenal adipose tissue are associated with soft pancreas texture and the risk of CR-POPF.

Keywords: Anastomotic leak; Computed tomography; Pancreatic fistula; Pancreatoduodenectomy; Soft pancreas.

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References

    1. Pedrazzoli S (2017) Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF). Medicine (United States) 96(19):e6858
    1. McMillan MT, Allegrini V, Asbun HJ, Ball CG, Bassi C, Beane JD et al (2017) Incorporation of procedure-specific risk into the ACS-NSQIP surgical risk calculator improves the Prediction of Morbidity and Mortality after Pancreatoduodenectomy. Ann Surg 265(5):978–986 - DOI
    1. Marchegiani G, Bassi C (2021) Prevention, prediction, and mitigation of postoperative pancreatic fistula. British J Surg NLM (Medline) 108(6):602–604 - DOI
    1. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery (United States) 161(3):584–591
    1. Søreide K, Healey AJ, Mole DJ, Parks RW (2019) Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery. HPB 21(12):1621–1631 - DOI

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