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Correlation between Preoperative Imaging and Intraoperative Risk Assessment in the Prediction of Postoperative Pancreatic Fistula Following Pancreatoduodenectomy

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Abstract

Background

Prediction of postoperative pancreatic fistula (POPF) can be carried out with the intraoperative assessment of pancreatic consistency (PC) and via pancreatic duct width (iPDW). Preoperative computed tomography (CT) calculated pancreatic remnant volume (PRV) and duct width (rPDW) have also been shown to offer useful information about the risk of POPF.

Objective

The objective of this study was to determine the predictive value of the preoperative radiological features as compared with the intraoperative risk estimation for the subsequent development of POPF.

Method

All patients undergoing pancreatoduodenectomy between September 2007 and March 2012 at the Karolinska University Hospital Stockholm were included. PRV and rPDW were determined on preoperative CT and in parallel, intraoperative PC and iPDW of the remnant pancreas were independently assessed.

Results

A total of 296 consecutive pancreatoduodenectomies were included. POPF occurred in 45 patients (15.2 %). Of those with a preoperatively calculated PRV < 23.0 cm3, 2.8 % developed POPF compared with 25.7 % of those with a corresponding volume > 46.0 cm3. In patients with an rPDW > 7.0 mm, 4.1 % had a POPF as compared with 38.7 % for those with rPDW < 2.0 mm. The POPF risk estimates based on PRV and rPDW and the intraoperative risk assessments were found to be identical (p < 0.001). In the receiver operating characteristic analysis, area under the curve was 0.80 (95 % confidence interval [CI] 0.72–0.87) and 0.80 (95 % CI 0.72–0.88) for the CT-based and intraoperative risk prediction models, respectively.

Conclusions

Preoperative CT-based and intraoperative gland risk assessments offer comparable predictive information on the risk of POPF after pancreatoduodenectomy. These results imply that accurate POPF risk estimation can be carried out in the preoperative setting to opt for improved patient selection into relevant research protocols and the availability of surgical expertise and techniques.

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Authors and Affiliations

  1. Department of Clinical Science, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden

    Farshad Frozanpor

  2. Department of Surgery, Danderyd Hospital, SE-182 88, Stockholm, Sweden

    Farshad Frozanpor

  3. Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden

    Louiza Loizou, Christoph Ansorge, Lars Lundell, Nils Albiin & Ralf Segersvärd

  4. Department of Radiology, Karolinska University Hospital, Stockholm, Sweden

    Louiza Loizou & Nils Albiin

  5. Department of Surgical Gastroentrology, Karolinska University Hospital, Stockholm, Sweden

    Christoph Ansorge, Lars Lundell & Ralf Segersvärd

Authors
  1. Farshad Frozanpor
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  2. Louiza Loizou
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  3. Christoph Ansorge
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  4. Lars Lundell
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  5. Nils Albiin
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  6. Ralf Segersvärd
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Correspondence to Farshad Frozanpor.

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Frozanpor, F., Loizou, L., Ansorge, C. et al. Correlation between Preoperative Imaging and Intraoperative Risk Assessment in the Prediction of Postoperative Pancreatic Fistula Following Pancreatoduodenectomy. World J Surg 38, 2422–2429 (2014). https://doi.org/10.1007/s00268-014-2556-5

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  • DOI: https://doi.org/10.1007/s00268-014-2556-5

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