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A novel preoperative predictor of pancreatic fistula using computed tomography after distal pancreatectomy with staple closure

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Abstract

Purpose

A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP.

Methods

One hundred and twenty-two patients were retrospectively assessed to determine the correlation between PF occurrence and the clinicopathological findings and radiologic data from preoperative computed tomography (CT). CT assessments included the thickness of the pancreas (TP) and pancreatic CT number (pancreatic index; PI), calculated by dividing the pancreatic CT by the splenic CT density.

Results

Twenty-four patients (19.7%) developed a clinically relevant PF. TP was identified as an independent risk factor for PF in multivariate analyses (odds ratio 1.17; P = 0.0095). In subgroup analyses, a lower PI in a thick pancreas was a significant predictor of PF (P = 0.032). The combination of these two prediction parameters, known as the TP-to-PI ratio (TPIR), showed a significantly better prediction ability than TP alone (area under the receiver operating characteristic curve for the incidence of PF, TPIR 0.80 vs. TP 0.69; P = 0.037).

Conclusion

Combining the CT number with TP substantially improves the prediction ability for the incidence of PF following DP with staple use.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan

    Yasunari Fukuda, Daisaku Yamada, Hidetoshi Eguchi, Yoshifumi Iwagami, Takehiro Noda, Tadafumi Asaoka, Hiroshi Wada, Koichi Kawamoto, Kunihito Gotoh, Masaki Mori & Yuichiro Doki

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  1. Yasunari Fukuda
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  2. Daisaku Yamada
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  3. Hidetoshi Eguchi
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Correspondence to Hidetoshi Eguchi.

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595_2017_1495_MOESM1_ESM.tif

Correlation between the PI and histological pancreatic changes in resected specimens. PI Pancreatic index. Box plot of the PI in two groups according to the presence or absence of pancreatic fatty degeneration and fibrosis in resected specimens. Histological pancreatic fatty and fibrotic changes were evaluated at the resection stump at > 15 mm from the tumor in order to avoid any tumor-associated pathological changes. More than 5% of fatty degeneration and more than 10% of fibrosis were defined as positive changes in accordance with our previous study [34]. We assessed these histological changes in 34 patients. (A) Regarding fatty degeneration, the PI was significantly lower in patients with positive changes than in those with negative changes (0.65 vs. 0.86; P=0.041). (B) There was no significant correlation between the PI and pancreatic fibrosis (patients with positive changes, 0.72 vs. patients with negative changes, 0.86; P=0.48).

595_2017_1495_MOESM2_ESM.tif

Correlation between the PI and drain amylase level. PI Pancreatic index. The scatter diagram represents the correlation between the PI and maximum drain amylase level on postoperative days 1 to 3. There was no significant correlation between the PI and drain amylase level (r2=0.012, P=0.21) (TIF 301 KB)

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Fukuda, Y., Yamada, D., Eguchi, H. et al. A novel preoperative predictor of pancreatic fistula using computed tomography after distal pancreatectomy with staple closure. Surg Today 47, 1180–1187 (2017). https://doi.org/10.1007/s00595-017-1495-9

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  • DOI: https://doi.org/10.1007/s00595-017-1495-9

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