Abstract
Objective
To assess the correlation between pancreatic quantitative edge analysis as a surrogate of parenchymal stiffness and the incidence of postoperative pancreatic fistula (POPF), in patients undergoing pancreaticoduodenectomy (PD).
Methods
All consecutive patients who underwent PD at our Institution between March 2018 and November 2019 with an available preoperative CT were included. Pancreatic margin score (PMS) was calculated through computer-assisted quantitative edge analysis on the margins of the pancreatic body and tail (the expected pancreatic remnant) on non-contrast scans with in-house software. Intraoperative assessment of pancreatic stiffness by manual palpation was also performed, classifying pancreatic texture into soft and non-soft. PMS values were compared between groups using an unpaired T-test and correlated with the intraoperative evaluation of stiffness and with the grading of postoperative pancreatic fistula according to the International Study Group on Pancreatic Surgery (ISGPS).
Results
Patient population included 200 patients (mean age 64.6 years), 146 without onset of POPF (73%, non-POPF group), and 54 with POPF (27%, POPF group).
A significant difference in PMS values was observed between POPF and non-POPF (respectively 1.88 ± 0.05 vs 0.69 ± 0.01; p < 0.0001). PMS values of pancreatic parenchymas intraoperatively considered “soft” were significantly higher than those evaluated as “non-soft” (1.21 ± 0.04 vs 0.73 ± 0.02; p < 0.0001). A significant correlation between PMS values and POPF grade was observed (r = 0.8316), even in subgroups of patients with soft (r = 0.8016) and non-soft (r = 0.7602) pancreas (all p < 0.0001).
Conclusions
Quantitative edge analysis with dedicated software may stratify patients with different pancreatic stiffness, thus potentially improving preoperative risk assessment and strategies for POPF mitigation.
Clinical relevance statement
This study proposes quantitative pancreas edge analysis as a predictor for postoperative pancreatic fistula. The test has high accuracy and correlation with fistula grade according to the International Study Group on Pancreatic Surgery.
Key Points
• Prediction of postoperative pancreatic fistula (POPF) onset risk after pancreaticoduodenectomy is based only on intraoperative evaluation.
• Quantitative edge analysis may preoperatively identify patients with higher risk of POPF.
• Quantification of pancreatic stiffness through the analysis of pancreatic margins could be done on preoperative CT.
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Abbreviations
- AUROC:
-
Area under the ROC curve
- BMI:
-
Body mass index
- CT:
-
Computed tomography
- ERAS:
-
Enhanced recovery after surgery
- FRS:
-
Fistula Risk Score
- ISGPS:
-
International Study Group on Pancreatic Surgery
- MRI:
-
Magnetic resonance imaging
- PD:
-
Pancreaticoduodenectomy
- PMS:
-
Pancreatic margin score
- POPF:
-
Postoperative pancreatic fistula
- SD:
-
Standard deviation
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Acknowledgements
Department of Physics and Astronomy “Galileo Galilei”, Padova, Italy
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The scientific guarantor of this publication is Professor Giulia A. Zamboni.
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Giulia A. Zamboni is a member of the European Radiology Editorial Board. She has not taken part in the review or selection process of this article.
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
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One of the authors has significant statistical expertise.
No complex statistical methods were necessary for this paper.
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Informed consent for the utilization of clinical and radiologic data was provided by all patients (PAD-R registry, n1101CESC).
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Institutional Review Board approval was obtained (Comitato etico per la sperimentazione clinica [CESC]).
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported as scientific poster at ESGAR 2022 with the title “Quantitative edge analysis of pancreatic margins in Patients with pancreatic head adenocarcinoma: correlations between pancreatic margins and onset of postoperative pancreatic fistula”. Gasparini C, Ambrosetti MC, Zamboni GA, Ambrosetti A, Marchegiani G, Perri G, Salvia R, Montemezzi S, Mansueto G.
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• Retrospective
• Observational
• Performed at one institution
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Ambrosetti, MC., Ambrosetti, A., Perri, G. et al. Quantitative edge analysis of pancreatic margins in patients with head pancreatic tumors: correlations between pancreatic margins and the onset of postoperative pancreatic fistula. Eur Radiol 34, 1515–1523 (2024). https://doi.org/10.1007/s00330-023-10200-6
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DOI: https://doi.org/10.1007/s00330-023-10200-6