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18.10.2017 | 2017 SSAT Quick Shot Presentation | Ausgabe 1/2018

Journal of Gastrointestinal Surgery 1/2018

Postoperative Visceral Tissue Edema Assessed by Computed Tomography Is a Predictor for Severe Complications After Pancreaticoduodenectomy

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 1/2018
Autoren:
Atsushi Shimizu, Manabu Kawai, Seiko Hirono, Ken-ichi Okada, Motoki Miyazawa, Yuji Kitahata, Masaki Ueno, Shinya Hayami, Atsushi Miyamoto, Yoshiki Kimoto, Toshio Shimokawa, Hiroki Yamaue
Wichtige Hinweise
The content of this paper was presented at the Digestive Disease Week 2017, 9th May 2017, Chicago, IL as Society for Surgery of the Alimentary Tract ‘Quick Shot’ Presentation.

Abstract

Background/Aims

In pancreatoduodenectomy (PD), the adverse impact of tissue edema owing to intraoperative fluid overload remains unclear. This study aims to evaluate how visceral tissue edema due to fluid overload affects severe postoperative complications after PD. It aims to clarify the usefulness of assessment by computed tomography (CT) of postoperative tissue edema.

Methods

We classified 200 patients who underwent PD as either liberal fluid management (LFM) group (n = 100) or goal-directed fluid therapy (GDFT) group (n = 100), based on intraoperative fluid management. We assessed postoperative tissue edema by cross section of the body trunk area using pre- and postoperative CT.

Results

Severe complication (Clavien-Dindo more than grade III) rate was significantly higher in LFM group than GDFT group (37 vs. 17%, P = 0.001). Independent risk factors of severe complications after PD included diameter of main pancreatic duct ≤ 3 mm at the cut surface (P = 0.041; OR 2.274; 95% CI 1.034–5.001), LFM (P = 0.005; OR 2.720; 95% CI 1.355–5.462), and increased rate of body trunk area ≥ 20% (P < 0.001; OR 3.448; 95% CI 1.723–5.462). In subgroup analysis of patients with no transfusion, LFM and increased rate of body trunk area ≥ 20% were independent risk factors of severe postoperative complications.

Conclusions

Visceral tissue edema evaluation is a valuable method to predict severe complications after PD.

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