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Hypoattenuated Area at Pancreatojejunostomy Site After Pancreatoduodenectomy Predicts Grade B/C Postoperative Pancreatic Fistula

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

After pancreatojejunostomy for pancreatic head resection, contrast-enhanced computed tomography sometimes reveals a hypoattenuated area at the pancreatojejunostomy site. The clinical impact of this hypoattenuated area, in terms of postoperative pancreatic fistula, is unknown.

Methods

Among 309 patients undergoing pancreatic head resection with pancreatojejunostomy reconstruction at Osaka University Hospital from 2012 to 2020, 105 exhibited drain amylase levels over 3× the upper limit of normal. According to contrast-enhanced computed tomography on postoperative days 3–14, these patients were divided into two groups—evident hypoattenuated area group (≥ 5 mm; n = 46) and subtle hypoattenuated area group (< 5 mm; n = 59)—and evaluated for clinically relevant pancreatic fistula.

Results

Clinically relevant pancreatic fistula was significantly more common with the evident hypoattenuated group (80.4%; 37/46) than the subtle hypoattenuated group (40.7%; 24/59) (P < 0.0001). Multivariate analysis identified four factors related to clinically relevant pancreatic fistula formation: male sex (P = 0.0230), main pancreatic duct diameter < 3 mm (P = 0.0007), operative time > 475 min (P = 0.0161), and evident hypoattenuated area group (P = 0.0050). Hypoattenuated area ≥ 5 mm was associated with clinically relevant pancreatic fistula (60.7% sensitivity; 79.6% specificity).

Conclusion

Evident hypoattenuated area on postoperative contrast-enhanced computed tomography was an independent risk factor for clinically relevant pancreatic fistula. Patients experiencing increased drain amylase levels may benefit from contrast-enhanced computed tomography assessment to predict clinically relevant pancreatic fistula formation.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan

    Hiroki Imamura, Yoshito Tomimaru, Shogo Kobayashi, Hidenori Takahashi, Kazuki Sasaki, Yoshifumi Iwagami, Daisaku Yamada, Takehiro Noda, Yuichiro Doki & Hidetoshi Eguchi

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  1. Hiroki Imamura
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  2. Yoshito Tomimaru
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  3. Shogo Kobayashi
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  4. Hidenori Takahashi
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  7. Daisaku Yamada
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Contributions

HI, YT, and HT have made substantial contributions to the conception and design of the work and the acquisition, analysis, and interpretation of data and have drafted the work and revised it. SK and HE have made substantial contributions to the conception and design of the work and the analysis and interpretation of data. KS, YI, DY, TN, YD have made substantial contributions to the conception and design of the work and have drafted the work and revised it. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shogo Kobayashi.

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Ethics Approval and Consent to Participate

The current study has been approved by the research ethics committee of Osaka University Hospital with approval number 22096, and it conforms to the Declaration of Helsinki. All informed consent was obtained from the subjects.

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The authors declare no competing interests.

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Imamura, H., Tomimaru, Y., Kobayashi, S. et al. Hypoattenuated Area at Pancreatojejunostomy Site After Pancreatoduodenectomy Predicts Grade B/C Postoperative Pancreatic Fistula. J Gastrointest Surg 27, 1159–1166 (2023). https://doi.org/10.1007/s11605-023-05625-9

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