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15.11.2023 | Pancreatic Tumors

Simple Preoperative Imaging Measurements Predict Postoperative Pancreatic Fistula After Pancreatoduodenectomy

verfasst von: Caitlin Sok, MD, PhD, Sameer Sandhu, MD, Hardik Shah, MD, Pranay S. Ajay, MD, Maria C. Russell, MD, Kenneth Cardona, MD, Felipe Maegawa, MD, Shishir K. Maithel, MD, Juan Sarmiento, MD, Subir Goyal, PhD, MPH, MBBS, David A. Kooby, MD, Mihir M. Shah, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 3/2024

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Abstract

Objective

Postoperative pancreatic fistula is a potentially devastating complication after pancreatoduodenectomy (PD). The purpose of this study was to identify features on preoperative computed tomography (CT) imaging that correlate with an increased risk of postoperative pancreatic fistula (POPF).

Methods

Patients who underwent PD at our high-volume pancreatic surgery center from 2019 to 2021 were included if CT imaging was available within 8 weeks of surgical intervention. Pancreatic neck thickness (PNT), abdominal wall thickness (AWT), and intra-abdominal distance from pancreas to peritoneum (PTP) were measured by two board-certified radiologists who were blinded to the clinical outcomes. Radiographic measurements, as well as preoperative patient characteristics and intraoperative data, were assessed with univariate and multivariable analysis (MVA) to determine risk for clinically relevant POPF (CR-POPF, grades B and C).

Results

A total of 204 patients met inclusion criteria. Median PTP was 5.8 cm, AWT 1.9 cm, and PNT 1.3 cm. CR-POPF occurred in 33 of 204 (16.2%) patients. MVA revealed PTP > 5.8 cm (odds ratio [OR] 2.86, p = 0.023), PNT > 1.3 cm (OR 2.43, p = 0.047), soft pancreas consistency (OR 3.47, p = 0.012), and pancreatic duct size ≤ 3.0 mm (OR 4.55, p = 0.01) as independent risk factors for CR-POPF after PD. AWT and obesity were not associated with increased risk of CR-POPF. Patients with PTP > 5.8 cm or PNT > 1.3 cm were significantly more likely to suffer a major complication after PD (39.6% vs. 22.3% and 40% vs. 22.1%, p < 0.008).

Conclusions

Patients with a thick pancreatic neck and increased intra-abdominal girth have a heightened risk of CR-POPF after pancreatoduodenectomy, and they experience more serious postoperative complications. We defined a simple CT scan-based measurement tool to identify patients at increased risk of CR-POPF.

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Titel: Simple Preoperative Imaging Measurements Predict Postoperative Pancreatic Fistula After Pancreatoduodenectomy
verfasst von: Caitlin Sok, MD, PhD
Sameer Sandhu, MD
Hardik Shah, MD
Pranay S. Ajay, MD
Maria C. Russell, MD
Kenneth Cardona, MD
Felipe Maegawa, MD
Shishir K. Maithel, MD
Juan Sarmiento, MD
Subir Goyal, PhD, MPH, MBBS
David A. Kooby, MD
Mihir M. Shah, MD
Publikationsdatum: 15.11.2023
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 3/2024
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14564-3

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Simple Preoperative Imaging Measurements Predict Postoperative Pancreatic Fistula After Pancreatoduodenectomy