Preoperative CT enhancement pattern in the pancreatic isthmus may predict clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy

Abstract Background Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p = 0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P = 0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P = 0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P = 0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

Download Full-text

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

10.21203/rs.3.rs-53308/v3 ◽

2020 ◽

Author(s):

Jun Kinoshita ◽

Takahisa Yamaguchi ◽

Hiroto Saito ◽

Hideki Moriyama ◽

Mari Shimada ◽

...

Keyword(s):

Gastric Cancer ◽

Pancreatic Fistula ◽

Left Gastric Artery ◽

Postoperative Pancreatic Fistula ◽

Open Gastrectomy ◽

Amylase Level ◽

Prognostic Impact ◽

Anatomic Location ◽

Significant Difference ◽

Preoperative Ct

Abstract Background: Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods: In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results: Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p=0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P=0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P=0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P=0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions: The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

Download Full-text

Evaluation of preoperative CT parameters associated with postoperative pancreatic fistula after pancreaticoduodenectomy

HPB ◽

10.1016/j.hpb.2019.10.1089 ◽

2019 ◽

Vol 21 ◽

pp. S912

Author(s):

F. Giovinazzo ◽

F. Soggiu ◽

R. Mitchell-Hay ◽

J. Straiton ◽

M. Mariappan ◽

...

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Preoperative Ct

Download Full-text

Preoperative CT anthropometric measurements and pancreatic pathology increase risk for postoperative pancreatic fistula in patients following pancreaticoduodenectomy

PLoS ONE ◽

10.1371/journal.pone.0243515 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243515

Author(s):

Yun Hwa Roh ◽

Bo Kyeong Kang ◽

Soon-Young Song ◽

Chul-Min Lee ◽

Yun Kyung Jung ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

International Study ◽

Multivariate Regression Analysis ◽

Postoperative Pancreatic Fistula ◽

Increase Risk ◽

Preoperative Ct ◽

Independent Risk Factors ◽

Definition Of ◽

Pancreatic Pathology

Postoperative pancreatic fistula (POPF) is a common complication following pancreaticoduodenectomy (PD). However, risk factors for this complication remain controversial. We conducted a retrospective analysis of 107 patients who underwent PD. POPF was diagnosed in strict accordance with the definition of the 2016 update of pancreatic fistula from the International Study Group on Pancreatic Fistula (ISGPF). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POPF. A total of 19 (17.8%) subjects of pancreatic fistula occurred after PD, including 15 (14.1%) with grade B POPF and 4 (3.7%) with grade C POPF. There were 33 (30.8%) patients with biochemical leak. Risk factors for POPF (grade B and C) were larger area of visceral fat (odds ratio [OR], 1.40; p = 0.040) and pathology other than pancreatic adenocarcinoma or pancreatitis (OR, 12.45; p = 0.017) in the multivariate regression analysis. This result could assist the surgeon to identify patients at a high risk of developing POPF.

Download Full-text

Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy

Medicina ◽

10.3390/medicina57070650 ◽

2021 ◽

Vol 57 (7) ◽

pp. 650

Author(s):

Marius Lucian Savin ◽

Florin Mihai ◽

Liliana Gheorghe ◽

Corina Lupascu Ursulescu ◽

Dragos Negru ◽

...

Keyword(s):

Regression Analysis ◽

Ct Scan ◽

Pancreatic Fistula ◽

Multiple Regression Analysis ◽

Multiple Regression ◽

Characteristic Curve ◽

Univariate Analysis ◽

Postoperative Pancreatic Fistula ◽

Preoperative Ct ◽

Correlated Parameters

Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 ± 6.8 HU vs. 50.4 ± 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, p = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, p = 0.02) and ERPV (46.37 ± 10.39 cm3 vs. 34.87 ± 12.35 cm3, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694–0.941) and 0.774 (95% CI 0.599–0.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.

Download Full-text

Evaluation of preoperative CT parameters associated with postoperative pancreatic fistula after pancreaticoduodenectomy

HPB ◽

10.1016/j.hpb.2019.10.548 ◽

2019 ◽

Vol 21 ◽

pp. S694

Author(s):

F. Giovinazzo ◽

F. Soggiu ◽

R. Mitchell-Hay ◽

J. Straiton ◽

M. Mariappan ◽

...

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Preoperative Ct

Download Full-text

Computed Tomography Enhancement Pattern of the Pancreatic Parenchyma Predicts Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Pancreas ◽

10.1097/mpa.0000000000001229 ◽

2019 ◽

Vol 48 (2) ◽

pp. 209-215 ◽

Cited By ~ 6

Author(s):

Hiromitsu Maehira ◽

Hiroya Iida ◽

Haruki Mori ◽

Naomi Kitamura ◽

Toru Miyake ◽

...

Keyword(s):

Computed Tomography ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Enhancement Pattern ◽

Pancreatic Parenchyma

Download Full-text

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

10.21203/rs.3.rs-53308/v2 ◽

2020 ◽

Author(s):

Jun Kinoshita ◽

Takahisa Yamaguchi ◽

Hiroto Saito ◽

Hideki Moriyama ◽

Mari Shimada ◽

...

Keyword(s):

Gastric Cancer ◽

Pancreatic Fistula ◽

Left Gastric Artery ◽

Postoperative Pancreatic Fistula ◽

Open Gastrectomy ◽

Amylase Level ◽

Prognostic Impact ◽

Anatomic Location ◽

Significant Difference ◽

Preoperative Ct

Abstract Background: Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG).Methods: In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results: Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p=0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P=0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P=0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P=0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients.Conclusions: The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

Download Full-text

Comparison of preoperative CT-based imaging parameters to predict postoperative pancreatic fistula

Clinical Radiology ◽

10.1016/j.crad.2016.06.108 ◽

2016 ◽

Vol 71 (10) ◽

pp. 986-992 ◽

Cited By ~ 6

Author(s):

K.J. Roberts ◽

S. Karkhanis ◽

M. Pitchaimuthu ◽

M.S. Khan ◽

J. Hodson ◽

...

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Imaging Parameters ◽

Preoperative Ct

Download Full-text

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

10.21203/rs.3.rs-53308/v1 ◽

2020 ◽

Author(s):

Jun Kinoshita ◽

Takahisa Yamaguchi ◽

Hiroto Saito ◽

Hideki Moriyama ◽

Mari Shimada ◽

...

Keyword(s):

Gastric Cancer ◽

Pancreatic Fistula ◽

Left Gastric Artery ◽

Postoperative Pancreatic Fistula ◽

Open Gastrectomy ◽

Amylase Level ◽

Prognostic Impact ◽

Anatomic Location ◽

Significant Difference ◽

Preoperative Ct

Abstract Background Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p = 0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P = 0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P = 0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P = 0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥ 12.4 mm) or high P-A length (≥ 45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

Download Full-text