Histological pancreatic findings correlate with computed tomography attenuation and predict postoperative pancreatic fistula following pancreatoduodenectomy |
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| Affiliation: | 1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan;2. Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan;3. Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan;4. Division of Pathology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan;1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;2. Department of Surgery, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany;3. Epidemiologist, Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands;4. Department of Surgery, Erasmus MC, Rotterdam, the Netherlands;1. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA;2. Universidad Cientifica del Sur, Lima, Peru;3. Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Austria;4. Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery and Department of Health Services Research, Mayo Clinic, Rochester, USA;5. Center of Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Austria;6. Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria;1. Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;2. Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;1. Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick NJ, USA;2. Department of Surgery, University of Toledo Medical Center, OH, USA;3. University of Cincinnati College of Medicine, OH, USA;4. Albany Medical College, NY, USA;1. Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India;2. Pediatric Gastroenterologist & Hepatologist, Institute of Digestive & Liver Care, S. L. Raheja Hospital (A Fortis Associate), Mahim, Mumbai, India;3. Department of Zoology, University of Rajasthan, Jaipur, Rajasthan, India |
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| Abstract: | BackgroundAlthough a soft pancreas is a widely-accepted reliable risk factor for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD), there is no established preoperative evaluation of pancreatic texture.MethodsTwo hundred thirty-seven patients who underwent PD with histological pancreatic assessment were retrospectively enrolled. The degree of fibrosis and fatty infiltration was scored histologically as seven grades and five grades, respectively. Computed tomography (CT) attenuation of the pancreas was measured on preoperative unenhanced CT images. Correlations between the CT attenuation of the pancreas and the histological pancreatic findings, and the development of POPF were analyzed.ResultsThe fibrosis grade was significantly higher for hard pancreas than for soft pancreas (p < 0.001), whereas the fatty infiltration grade was similar between the two types (p = 0.161). CT attenuation of the pancreas was inversely correlated with both fibrosis grade (Spearman's rank correlation coefficient ([r] = ?0.609, p < 0.001) and fatty infiltration grade (r = ?0.382, p < 0.001). Multivariate analysis showed that body mass index ≥25 kg/m2 (odds ratio [OR]: 5.64, p < 0.001) and fibrosis grade ≤2 (OR: 18.0, p < 0.001) were independent risk factors for clinically significant POPF.ConclusionHistological pancreatic texture can be evaluated with CT attenuation and might be helpful in preoperatively predicting the development of POPF after PD. |
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