Multidetector CT findings differ between surgical grades of pancreatic fistula after pancreaticoduodenectomy
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To define and correlate multidetector CT (MDCT) findings of pancreatic fistula after pancreaticoduodenectomy with surgical grading based on the 2016 Revised International Study Group of Pancreatic Fistula (ISGPF) classification.
Between May 2011 and December 2016, 235 patients with periampullary tumor underwent pancreaticoduodenectomy and postoperative MDCT. Patients were classified into three groups (clinically no pancreatic fistula (cNo-PF), grade B, and grade C) according to the ISGPF classification. MDCT images were retrospectively evaluated by two radiologists in consensus for the presence of pancreaticojejunostomy (PJ) dehiscence, PJ dehiscence diameter, PJ defect, acute necrotic collection (ANC), peripancreatic fluid collection, and imaging findings of complications. Categorical MDCT findings were compared among the three groups using Pearson’s chi-square test, and PJ dehiscence diameter was compared using the Kruskal–Wallis test.
There was no significant difference in patient demographics among the groups (cNo-PF = 133, grade B = 68, and grade C = 34), but the MDCT findings were significantly different regarding the presence of PJ dehiscence (p < 0.001), PJ defect (p < 0.001), ANC (p = 0.002), and imaging findings of total complications (p < 0.001). The diameters of PJ dehiscence were significantly different among the groups (cNo-PF [0.42 ± 1.54 mm], grade B [1.47 ± 2.33 mm], and grade C [5.38 ± 6.45 mm]) (p < 0.001).
With respect to the presence of PF, postoperative MDCT findings may differ between surgical grading based on the ISGPF classification.
• Regarding the presence of pancreatic fistula, the postoperative multidetector CT findings correlate well with surgical grading based on the International Study Group of Pancreatic Fistula classification.
• Multidetector CT may provide reliable information to suggest pancreatic fistula after pancreaticoduodenectomy.
KeywordsPancreaticoduodenectomy Pancreatic fistula Pancreaticojejunostomy Postoperative complications
Acute necrotic collection
Area under the receiver operating characteristic curve
Clinically no pancreatic fistula
2016 Revised International Study Group of Pancreatic Fistula
- PJ defect
- PJ dehiscence
Postoperative pancreatic fistula
This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2017R1D1A3B04033613).
Compliance with ethical standards
The scientific guarantor of this publication is Jin Woong Kim.
Conflict of interest
Jin Woong Kim, MD, PhD, has received research grants from the National Research Foundation of Korea (NRF) (No. 2017R1D1A3B04033613). Hyo-jae Lee, Young Hoe Hur, Byung Kook Lee, Sung Bum Cho, Eu Chang Hwang, Seung Jin Lee, Eun Ju Yoon, and Hyun Ju Seon declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Byung Kook Lee and Eu Chang Hwang kindly provided statistical advice for this manuscript.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained (No.: CNUHH-2017-140).
• diagnostic or prognostic study
• performed at one institution
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