Pancreas-visceral fat CT value ratio and serrated pancreatic contour are strong predictors of postoperative pancreatic fistula after pancreaticojejunostomy
Tomoki Kusafuka,
Hiroyuki Kato,
Yusuke Iizawa,
Daisuke Noguchi,
Kazuyuki Gyoten,
Aoi Hayasaki,
Takehiro Fujii,
Yasuhiro Murata,
Akihiro Tanemura,
Naohisa Kuriyama,
Yoshinori Azumi,
Masashi Kishiwada,
Shugo Mizuno,
Masanobu Usui,
Hiroyuki Sakurai,
Shuji Isaji
Affiliations
Tomoki Kusafuka
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Hiroyuki Kato
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Yusuke Iizawa
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Daisuke Noguchi
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Kazuyuki Gyoten
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Aoi Hayasaki
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Takehiro Fujii
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Yasuhiro Murata
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Akihiro Tanemura
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Naohisa Kuriyama
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Yoshinori Azumi
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Masashi Kishiwada
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Shugo Mizuno
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Masanobu Usui
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Hiroyuki Sakurai
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Shuji Isaji
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Abstract Background Our aim is to elucidate the true preoperative risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), making it possible to select POPF high-risk patients preoperatively regardless of intraoperative pancreatic consistency judged by the surgeon’s hand. Methods Among the 298 patients who underwent PD with pancreaticojejunostomy from 2007 to 2016, 262 patients had preoperative CT configurations that could be precisely evaluated. Risk factor analyses were conducted using various perioperative factors, including preoperative CT findings, such as CT values of the pancreas, pancreas-visceral fat CT value ratio and pancreatic outer contour. Pancreatic outer contour was further divided into smooth- (smooth interlobular) and serrated-type contours (feathery, irregular interlobular) by preoperative CT. Results In terms of the incidence of POPF, among the 262 patients, POPF grade B/C was found in 27 (10.3%): grade B in 23 (8.8%) and grade C in 4 (1.5%). According to multivariate analysis, a high pancreas-visceral fat CT value ratio (p = 0.002), serrated-type contour (p = 0.02) and no history of chemoradiotherapy (p = 0.019) were identified as independent risk factors for POPF grade B/C. Even in patients with soft pancreas, the incidence of POPF grade B/C was 0% (0/57) in patients with a pancreas-visceral fat CT value ratio of less than − 0.4 and smooth-type contour, whereas the incidence was markedly high (45.0%, 9/20) in patients with a pancreas-visceral fat CT value ratio of − 0.4 or greater and serrated-type contour, indicating that patients with soft pancreas should be categorized into POPF high-risk and low-risk groups according to preoperative CT scan results. Conclusions The pancreas-visceral fat CT value ratio and serrated-type pancreas are useful markers to preoperatively identify true POPF high-risk groups in patients undergoing PD, regardless of the pancreatic texture judged intraoperatively.
