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. 2022 Jun 22;22(1):240.
doi: 10.1186/s12893-022-01650-8.

Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

Koki Maeda  1   2 , Naohisa Kuriyama  3 , Takuya Yuge  1 , Takahiro Ito  1 , Kazuyuki Gyoten  1 , Aoi Hayasaki  1 , Takehiro Fujii  1 , Yusuke Iizawa  1 , Yasuhiro Murata  1 , Akihiro Tanemura  1 , Masashi Kishiwada  1 , Hiroyuki Sakurai  1 , Shugo Mizuno  1
Affiliations

Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

Koki Maeda et al. BMC Surg. .

Abstract

Background: In pancreaticoduodenectomy, the pancreas-visceral fat CT value ratio and serrated pancreatic contour on preoperative CT have been revealed as risk factors for postoperative pancreatic fistulas. We aimed to evaluate whether they could also serve as risk factors for postoperative pancreatic fistulas after distal pancreatectomy.

Methods: A total of 251 patients that underwent distal pancreatectomy at our department from 2006 to 2020 were enrolled for the study. We retrospectively analyzed risk factors for postoperative pancreatic fistulas after distal pancreatectomy using various pre and intraoperative factors, including preoperative CT findings, such as pancreas-visceral fat CT value ratio and serrated pancreatic contour.

Results: The study population included 147 male and 104 female participants (median age, 68 years; median body mass index, 21.4 kg/m2), including 64 patients with diabetes mellitus (25.5%). Preoperative CT evaluation showed a serrated pancreatic contour in 80 patients (31.9%), a pancreatic thickness of 9.3 mm (4.0-22.0 mm), pancreatic parenchymal CT value of 41.8 HU (4.3-22.0 HU), and pancreas-visceral fat CT value ratio of - 0.41 (- 4.88 to - 0.04). Postoperative pancreatic fistulas were developed in 34.2% of the patients. Univariate analysis of risk factors for postoperative pancreatic fistulas showed that younger age (P = 0.005), high body mass index (P = 0.001), absence of diabetes mellitus (P = 0.002), high preoperative C-reactive protein level (P = 0.024), pancreatic thickness (P < 0.001), and high pancreatic parenchymal CT value (P = 0.018) were significant risk factors; however, pancreas-visceral fat CT value ratio (P = 0.337) and a serrated pancreatic contour (P = 0.122) did not serve as risk factors. Multivariate analysis showed that high body mass index (P = 0.032), absence of diabetes mellitus (P = 0.001), and pancreatic thickness (P < 0.001) were independent risk factors.

Conclusion: The pancreas-visceral fat CT value ratio and serrated pancreatic contour evaluated using preoperative CT were not risk factors for postoperative pancreatic fistulas after distal pancreatectomy. High body mass index, absence of diabetes mellitus, and pancreatic thickness were independent risk factors, and a close-to-normal pancreas with minimal fat deposition or atrophy is thought to indicate a higher risk of postoperative pancreatic fistulas after distal pancreatectomy.

Keywords: CT value; Diabetes mellitus; Distal pancreatectomy; Postoperative pancreatic fistula; Serrated pancreas; Visceral fat.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Measurement of the CT value of the remnant pancreatic parenchyma (a) and visceral fat (b). HU Hounsfield units, PVFR pancreas-visceral fat ratio
Fig. 2
Fig. 2
Classification of pancreatic morphology. a Smooth type: smooth interlobular border. b Serrated type: feathery, irregular interlobular border, and a protrusion of more than 3 mm
Fig. 3
Fig. 3
ROC analysis of the risk factors for POPF after DP. ROC receiver operating characteristic, BMI body mass index, AUC area under the curve, PPV positive predictive value, NPV negative predictive value, POPF postoperative pancreatic fistula, DP distal pancreatectomy
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