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Quantitative Assessment of Pancreatic Texture Using a Durometer: A New Tool to Predict the Risk of Developing a Postoperative Fistula

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Abstract

Background

Pancreatic texture is one of the key predictors of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). Currently, the “gold standard” for assessment of pancreatic texture is surgeon’s subjective evaluation through manual palpation.

Aim

To evaluate a new “durometer” that is able to assess quantitatively the pancreatic stiffness by measuring its elastic module (i.e., the resistance offered by the pancreatic stump when elastically deformed expressed in mPa).

Methods

Measurements were obtained from the pancreatic remnant during 138 consecutive PDs performed at the Department of General and Pancreatic Surgery—The Pancreas Institute, University of Verona Hospital Trust. Values were correlated to clinical features and, in particular, with the senior surgeon’s evaluation of pancreatic texture (hard/soft). Sixteen beating-heart donors were used as a control group to assess the stiffness of a non-pathologic pancreas. Univariate analysis was performed for the assessment of POPF predictors.

Results

Durometry allowed segregating between non-pathologic, soft and hard pancreas according to surgeon’s evaluation (mean values 111 vs. 196 vs. 366 mPa, p < 0.01). There were no significant differences in stiffness with regard to histology, BMI, and neoadjuvant therapy. Larger tumors (>20 mm) and male sex were associated with greater stiffness on univariate analysis. Pancreatic texture, pancreatic duct size, BMI, prior neoadjuvant therapy, and histology were predictors of POPF. Patients who developed POPF showed a lesser stiffness (178 vs. 261 mPa, p = 0.05).

Conclusion

Assessment of pancreatic stiffness using a durometer correlated with the surgeon’s evaluation of pancreatic texture. Measurement of pancreatic parenchymal stiffness is reliable and correlates with the development of POPF.

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Acknowledgements

This work was supported by: Associazione Italiana Ricerca Cancro [AIRC n.12182 and n.17132]; Italian Ministry of Health [FIMP-CUP_J33G13000210001]; FP7 European Community Grant Cam-Pac [n. 602783]. The funding agencies had no role in the collection, analysis, and interpretation of data and in the writing of the manuscript.

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Authors and Affiliations

  1. Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy

    Giovanni Marchegiani, Giuseppe Malleo, Stefano Andrianello, Valentina Allegrini, Alessandra Pulvirenti, Marina Paini, Erica Secchettin, Claudio Bassi & Roberto Salvia

  2. Department of HPB and Transplant Surgery, Modena University, Modena, Italy

    Roberto Ballarin & Fabrizio Di Benedetto

  3. Department of Computer Science, Verona University, P.le Scuro 10, 37134, Verona, Italy

    Fabrizio Boriero

Authors
  1. Giovanni Marchegiani
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  2. Roberto Ballarin
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  3. Giuseppe Malleo
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  4. Stefano Andrianello
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  5. Valentina Allegrini
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  6. Alessandra Pulvirenti
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  7. Marina Paini
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  9. Fabrizio Boriero
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  11. Claudio Bassi
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  12. Roberto Salvia
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Correspondence to Giovanni Marchegiani.

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Marchegiani, G., Ballarin, R., Malleo, G. et al. Quantitative Assessment of Pancreatic Texture Using a Durometer: A New Tool to Predict the Risk of Developing a Postoperative Fistula. World J Surg 41, 2876–2883 (2017). https://doi.org/10.1007/s00268-017-4073-9

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  • DOI: https://doi.org/10.1007/s00268-017-4073-9

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