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Simple Preoperative Imaging Measurements Predict Postoperative Pancreatic Fistula After Pancreatoduodenectomy

  • Pancreatic Tumors
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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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Acknowledgment

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number K12 CA237806 from the Emory K12 Clinical Oncology Training Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support in part by the Contardi Research Fellowship and the Georgia CTSA UL1 Program (grant number UL1 TR002378). The acknowledged parties had no role in study design, data collection, analysis and interpretation of data, manuscript writing, and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine/Winship Cancer Institute, Atlanta, GA, USA

    Caitlin Sok MD, PhD, Pranay S. Ajay MD, Maria C. Russell MD, Kenneth Cardona MD, Felipe Maegawa MD, Shishir K. Maithel MD, Juan Sarmiento MD, David A. Kooby MD & Mihir M. Shah MD

  2. Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA

    Sameer Sandhu MD & Hardik Shah MD

  3. Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA, USA

    Subir Goyal PhD, MPH, MBBS

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  1. Caitlin Sok MD, PhD
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Sok, C., Sandhu, S., Shah, H. et al. Simple Preoperative Imaging Measurements Predict Postoperative Pancreatic Fistula After Pancreatoduodenectomy. Ann Surg Oncol 31, 1898–1905 (2024). https://doi.org/10.1245/s10434-023-14564-3

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