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Quantitative edge analysis of pancreatic margins in patients with head pancreatic tumors: correlations between pancreatic margins and the onset of postoperative pancreatic fistula

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

Abstract

Objective

To assess the correlation between pancreatic quantitative edge analysis as a surrogate of parenchymal stiffness and the incidence of postoperative pancreatic fistula (POPF), in patients undergoing pancreaticoduodenectomy (PD).

Methods

All consecutive patients who underwent PD at our Institution between March 2018 and November 2019 with an available preoperative CT were included. Pancreatic margin score (PMS) was calculated through computer-assisted quantitative edge analysis on the margins of the pancreatic body and tail (the expected pancreatic remnant) on non-contrast scans with in-house software. Intraoperative assessment of pancreatic stiffness by manual palpation was also performed, classifying pancreatic texture into soft and non-soft. PMS values were compared between groups using an unpaired T-test and correlated with the intraoperative evaluation of stiffness and with the grading of postoperative pancreatic fistula according to the International Study Group on Pancreatic Surgery (ISGPS).

Results

Patient population included 200 patients (mean age 64.6 years), 146 without onset of POPF (73%, non-POPF group), and 54 with POPF (27%, POPF group).

A significant difference in PMS values was observed between POPF and non-POPF (respectively 1.88 ± 0.05 vs 0.69 ± 0.01; p < 0.0001). PMS values of pancreatic parenchymas intraoperatively considered “soft” were significantly higher than those evaluated as “non-soft” (1.21 ± 0.04 vs 0.73 ± 0.02; p < 0.0001). A significant correlation between PMS values and POPF grade was observed (r = 0.8316), even in subgroups of patients with soft (r = 0.8016) and non-soft (r = 0.7602) pancreas (all p < 0.0001).

Conclusions

Quantitative edge analysis with dedicated software may stratify patients with different pancreatic stiffness, thus potentially improving preoperative risk assessment and strategies for POPF mitigation.

Clinical relevance statement

This study proposes quantitative pancreas edge analysis as a predictor for postoperative pancreatic fistula. The test has high accuracy and correlation with fistula grade according to the International Study Group on Pancreatic Surgery.

Key Points

• Prediction of postoperative pancreatic fistula (POPF) onset risk after pancreaticoduodenectomy is based only on intraoperative evaluation.

• Quantitative edge analysis may preoperatively identify patients with higher risk of POPF.

• Quantification of pancreatic stiffness through the analysis of pancreatic margins could be done on preoperative CT.

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Abbreviations

AUROC:

Area under the ROC curve

BMI:

Body mass index

CT:

Computed tomography

ERAS:

Enhanced recovery after surgery

FRS:

Fistula Risk Score

ISGPS:

International Study Group on Pancreatic Surgery

MRI:

Magnetic resonance imaging

PD:

Pancreaticoduodenectomy

PMS:

Pancreatic margin score

POPF:

Postoperative pancreatic fistula

SD:

Standard deviation

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Acknowledgements

Department of Physics and Astronomy “Galileo Galilei”, Padova, Italy

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata - Verona, P.Le Stefani 1, 37126, Verona, Italy

    Maria-Chiara Ambrosetti & Stefania Montemezzi

  2. Department of Physics and Astronomy “Galileo Galilei”, University of Padova, Padua, Italy

    Alberto Ambrosetti

  3. Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy

    Giampaolo Perri & Roberto Salvia

  4. Institute of Radiology, Department of Diagnostics and Public Health, Policlinico GB Rossi, University of Verona, Verona, Italy

    Clizia Gasparini, Giancarlo Mansueto & Giulia A. Zamboni

  5. Hepato Biliary Pancreatic (HPB) and Liver Transplant Surgery – DISCOG – Padova University Hospital, Padua, Italy

    Giovanni Marchegiani

Authors
  1. Maria-Chiara Ambrosetti
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  2. Alberto Ambrosetti
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  3. Giampaolo Perri
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  4. Clizia Gasparini
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  5. Giovanni Marchegiani
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  6. Roberto Salvia
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  7. Stefania Montemezzi
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  8. Giancarlo Mansueto
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  9. Giulia A. Zamboni
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Corresponding author

Correspondence to Maria-Chiara Ambrosetti.

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Guarantor

The scientific guarantor of this publication is Professor Giulia A. Zamboni.

Conflict of interest

Giulia A. Zamboni is a member of the European Radiology Editorial Board. She has not taken part in the review or selection process of this article.

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Informed consent for the utilization of clinical and radiologic data was provided by all patients (PAD-R registry, n1101CESC).

Ethical approval

Institutional Review Board approval was obtained (Comitato etico per la sperimentazione clinica [CESC]).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported as scientific poster at ESGAR 2022 with the title “Quantitative edge analysis of pancreatic margins in Patients with pancreatic head adenocarcinoma: correlations between pancreatic margins and onset of postoperative pancreatic fistula”. Gasparini C, Ambrosetti MC, Zamboni GA, Ambrosetti A, Marchegiani G, Perri G, Salvia R, Montemezzi S, Mansueto G.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Ambrosetti, MC., Ambrosetti, A., Perri, G. et al. Quantitative edge analysis of pancreatic margins in patients with head pancreatic tumors: correlations between pancreatic margins and the onset of postoperative pancreatic fistula. Eur Radiol 34, 1515–1523 (2024). https://doi.org/10.1007/s00330-023-10200-6

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  • DOI: https://doi.org/10.1007/s00330-023-10200-6

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