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Prediction of Pancreatic Fistula After Distal Pancreatectomy Based on Cross-Sectional Images

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Abstract

Background

Postoperative pancreatic fistula (POPF) is one of the most common and clinically relevant complications after distal pancreatectomy (DP), occurring in 5–40% of patients. Determining risk factors for this complication may aid in its prevention. This study sought to predict the development of POPF after DP preoperatively and objectively based on radiologic findings.

Methods

This study included 60 patients who underwent DP using a stapler for pancreatic division between June 2011 and January 2013. Fatty infiltration, apparent diffusion coefficients (ADC) on preoperative MRI, pathologic fat, and fibrosis were measured. Pancreatic thickness and cross-sectional area of the pancreas stump on CT scan were also measured.

Results

Mean patient age was 60.5 years, 26 patients (46.3%) had pancreatic cancer and 20 (33.3%) underwent laparoscopic surgery. Clinically relevant POPF was observed in 12 patients (20.0%). Linear regression analysis showed a significant correlation between fat quantification on MRI and pathologic fat (pathologic fat = 1.978 × MR fat −6.393, p < 0.001, R 2 = 0.777). Univariate analysis showed that ≤8% fat on MRI (p = 0.040), ≤5% pathologic fat (p = 0.002), ADC ≤ 1.3 × 10−3 mm2/s (p = 0.020), thicker pancreas (p = 0.007), and wider cross-sectional area of the pancreas (p = 0.013) were significantly associated with clinically relevant POPF after DP. Multivariate analysis revealed that pancreas thickness >17.6 mm [odds ratio (OR) 6.532, p = 0.064] and cross-sectional area >377 mm2 (OR 12.676, p = 0.052) were marginally related to clinically relevant POPF.

Conclusions

Pancreatic thickness and cross-sectional area of the transected surface of the pancreas are marginally significant risk factors for POPF development after DP. Measuring pancreatic thickness and cross-sectional area can be a promising tool for the preoperative prediction of POPF.

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Acknowledgements

The authors appreciate Jeong Hee Yoon, MD (Department of Radiology, Seoul National University Hospital, Republic of Korea) for the radiologic review and significant contribution of the revision of the manuscript. The authors appreciate Jeong Min Lee, MD (Department of Radiology, Seoul National University Hospital, Republic of Korea) and Stephan Kannengiesser, PhD (Siemens Healthineers, Germany) for the sequence and software validation.

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    Authors and Affiliations

    1. Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea

      Ye Rim Chang, Jae Seung Kang, Jin-Young Jang, Woo Hyun Jung, Mee Joo Kang & Sun-Whe Kim

    2. Department of Surgery, Dankook University College of Medicine, Cheonan, Korea

      Ye Rim Chang

    3. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

      Kyung Bun Lee

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    1. Ye Rim Chang
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    Ye Rim Chang and Jae Seung Kang have contributed equally to this study.

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    Chang, Y.R., Kang, J.S., Jang, JY. et al. Prediction of Pancreatic Fistula After Distal Pancreatectomy Based on Cross-Sectional Images. World J Surg 41, 1610–1617 (2017). https://doi.org/10.1007/s00268-017-3872-3

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