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Multidetector CT findings differ between surgical grades of pancreatic fistula after pancreaticoduodenectomy

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To define and correlate multidetector CT (MDCT) findings of pancreatic fistula after pancreaticoduodenectomy with surgical grading based on the 2016 Revised International Study Group of Pancreatic Fistula (ISGPF) classification.

Methods

Between May 2011 and December 2016, 235 patients with periampullary tumor underwent pancreaticoduodenectomy and postoperative MDCT. Patients were classified into three groups (clinically no pancreatic fistula (cNo-PF), grade B, and grade C) according to the ISGPF classification. MDCT images were retrospectively evaluated by two radiologists in consensus for the presence of pancreaticojejunostomy (PJ) dehiscence, PJ dehiscence diameter, PJ defect, acute necrotic collection (ANC), peripancreatic fluid collection, and imaging findings of complications. Categorical MDCT findings were compared among the three groups using Pearson’s chi-square test, and PJ dehiscence diameter was compared using the Kruskal–Wallis test.

Results

There was no significant difference in patient demographics among the groups (cNo-PF = 133, grade B = 68, and grade C = 34), but the MDCT findings were significantly different regarding the presence of PJ dehiscence (p < 0.001), PJ defect (p < 0.001), ANC (p = 0.002), and imaging findings of total complications (p < 0.001). The diameters of PJ dehiscence were significantly different among the groups (cNo-PF [0.42 ± 1.54 mm], grade B [1.47 ± 2.33 mm], and grade C [5.38 ± 6.45 mm]) (p < 0.001).

Conclusion

With respect to the presence of PF, postoperative MDCT findings may differ between surgical grading based on the ISGPF classification.

Key Points

• Regarding the presence of pancreatic fistula, the postoperative multidetector CT findings correlate well with surgical grading based on the International Study Group of Pancreatic Fistula classification.

• Multidetector CT may provide reliable information to suggest pancreatic fistula after pancreaticoduodenectomy.

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Abbreviations

ANC:

Acute necrotic collection

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence interval

cNo-PF:

Clinically no pancreatic fistula

ISGPF:

2016 Revised International Study Group of Pancreatic Fistula

MDCT:

Multidetector CT

PF:

Pancreatic fistula

PJ defect:

Pancreaticojejunostomy defect

PJ dehiscence:

Pancreaticojejunostomy dehiscence

POP:

Postoperative pancreatitis

POPF:

Postoperative pancreatic fistula

PPPD:

Pylorus-preserving pancreaticoduodenectomy

References

  1. Kawai M, Yamaue H (2010) Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today 40:1011–1017

    Article  PubMed  Google Scholar 

  2. Raman SP, Horton KM, Cameron JL, Fishman EK (2013) CT after pancreaticoduodenectomy: spectrum of normal findings and complications. AJR Am J Roentgenol 201:2–13

    Article  PubMed  Google Scholar 

  3. Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr (2007) Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 245:443–451

    Article  PubMed  PubMed Central  Google Scholar 

  4. Machado NO (2012) Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management-review. Int J Surg Oncol 2012:602478

    PubMed  Google Scholar 

  5. Lai ECH, Lau SHY, Lau WY (2009) Measures to prevent pancreatic fistula after pancreatoduodenectomy: a comprehensive review. Arch Surg 144:1074–1080

    Article  PubMed  Google Scholar 

  6. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  7. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591

    Article  PubMed  Google Scholar 

  8. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216:1–14

    Article  PubMed  Google Scholar 

  9. Strasberg SM, Drebin JA, Mokadam NA et al (2002) Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg 194:746–758 discussion 759–760

    Article  PubMed  Google Scholar 

  10. Bai X, Zhang Q, Gao S et al (2016) Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy: a prospective, randomized controlled trial from a single surgeon. J Am Coll Surg 222:10–18

    Article  PubMed  Google Scholar 

  11. Gervais DA, Fernandez-del Castillo C, O'Neill MJ, Hahn PF, Mueller PR (2001) Complications after pancreatoduodenectomy: imaging and imaging-guided interventional procedures. Radiographics 21:673–690

    Article  CAS  PubMed  Google Scholar 

  12. Banks PA, Bollen TL, Dervenis C et al (2013) Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111

    Article  PubMed  Google Scholar 

  13. Malleo G, Crippa S, Butturini G et al (2010) Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB (Oxford) 12:610–618

    Article  Google Scholar 

  14. Ho CK, Kleeff J, Friess H, Büchler MW (2005) Complications of pancreatic surgery. HPB (Oxford) 7:99–108

    Article  PubMed Central  Google Scholar 

  15. Coombs RJ, Zeiss J, Howard JM, Thomford NR, Merrick HW (1990) CT of the abdomen after the Whipple procedure: value in depicting postoperative anatomy, surgical complications, and tumor recurrence. AJR Am J Roentgenol 154:1011–1014

  16. Mortelé KJ, Lemmerling M, de Hemptinne B, De Vos M, De Bock G, Kunnen M (2000) Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features. Eur Radiol 10:123–128

    Article  PubMed  Google Scholar 

  17. Lepanto L, Gianfelice D, Déry R, Dagenais M, Lapointe R, Roy A (1994) Postoperative changes, complications, and recurrent disease after Whipple’s operation: CT features. AJR Am J Roentgenol 163:841–846

    Article  CAS  PubMed  Google Scholar 

  18. Thoeni RF (2012) The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 262:751–764

    Article  PubMed  Google Scholar 

  19. Hashimoto M, Koga M, Ishiyama K et al (2007) CT features of pancreatic fistula after pancreaticoduodenectomy. AJR Am J Roentgenol 188:W323–W327

    Article  PubMed  Google Scholar 

  20. Park SH, Goo JM, Jo CH (2004) Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol 5:11–18

    Article  PubMed  PubMed Central  Google Scholar 

  21. Schulick RD (2008) Complications after pancreaticoduodenectomy: intraabdominal abscess. J Hepatobiliary Pancreat Surg 15:252–256

    Article  PubMed  Google Scholar 

  22. Halloran CM, Ghaneh P, Bosonnet L, Hartley MN, Sutton R, Neoptolemos JP (2002) Complications of pancreatic cancer resection. Dig Surg 19:138–146

    Article  CAS  PubMed  Google Scholar 

  23. Otah E, Cushin BJ, Rozenblit GN, Neff R, Otah KE, Cooperman AM (2002) Visceral artery pseudoaneurysms following pancreatoduodenectomy. Arch Surg 137:55–59

    Article  PubMed  Google Scholar 

  24. Puppala S, Patel J, McPherson S, Nicholson A, Kessel D (2011) Hemorrhagic complications after Whipple surgery: imaging and radiologic intervention. AJR Am J Roentgenol 196:192–197

    Article  PubMed  Google Scholar 

  25. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174:331–336

    Article  CAS  PubMed  Google Scholar 

  26. McMillan MT, Soi S, Asbun HJ et al (2016) Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg 264:344–352

    Article  PubMed  Google Scholar 

  27. Tran KT, Smeenk HG, van Eijck CH et al (2004) Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240:738

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2017R1D1A3B04033613).

Author information

Author notes

  1. Jin Woong Kim and Young Hoe Hur contributed equally to this work and should be considered co-corresponding authors.

Authors and Affiliations

  1. Department of Radiology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju, Republic of Korea

    Hyo-jae Lee & Seung Jin Lee

  2. Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, #365 Pilmun-daero, Dong-gu, Gwangju, 61453, Republic of Korea

    Jin Woong Kim, Eun Ju Yoon & Hyun Ju Seon

  3. Department of Hepato-Pancreato-Biliary Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju, Republic of Korea

    Young Hoe Hur

  4. Department of Emergency Medicine, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju, Republic of Korea

    Byung Kook Lee

  5. Department of Internal Medicine, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju, Republic of Korea

    Sung Bum Cho

  6. Department of Urology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju, Republic of Korea

    Eu Chang Hwang

Authors
  1. Hyo-jae Lee
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Corresponding author

Correspondence to Jin Woong Kim.

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Guarantor

The scientific guarantor of this publication is Jin Woong Kim.

Conflict of interest

Jin Woong Kim, MD, PhD, has received research grants from the National Research Foundation of Korea (NRF) (No. 2017R1D1A3B04033613). Hyo-jae Lee, Young Hoe Hur, Byung Kook Lee, Sung Bum Cho, Eu Chang Hwang, Seung Jin Lee, Eun Ju Yoon, and Hyun Ju Seon declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Byung Kook Lee and Eu Chang Hwang kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (No.: CNUHH-2017-140).

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Lee, Hj., Kim, J.W., Hur, Y.H. et al. Multidetector CT findings differ between surgical grades of pancreatic fistula after pancreaticoduodenectomy. Eur Radiol 29, 2399–2407 (2019). https://doi.org/10.1007/s00330-018-5916-y

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  • DOI: https://doi.org/10.1007/s00330-018-5916-y

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