Computed Tomography Imaging Evaluation of Pancreatic Density and Muscular Mass as Predictive Risk Factors for Pancreatic Fistula Formation after Duodenocephalopancreasectomy

Abstract

The aim of this study was to investigate the predictive role of preoperative pancreatic density and muscular mass, assessed via CT imaging, in patients undergoing duodenocephalopancreasectomy, specifically in relation to the occurrence of postoperative pancreatic fistula (POPF). A retrospective analysis was conducted on a cohort of 57 consecutive patients who had been diagnosed with cephalo-pancreatic disease and had undergone duodenocephalopancreasectomy in the last five years. The most prevalent pathologies observed were ductal adenocarcinoma (29.2%), biliary adenocarcinoma (12.9%), and duodenal and papillary adenocarcinoma (13.9%). We collected information about age, sex, histopathological findings, type of surgery, presence or absence of pancreatic fistula, pancreatic density on preoperative CT images, and muscular area, calculated at the level of the L3 vertebra using “3D Slicer” software. Our data show that 28% of patients developed a pancreatic fistula, with an average attenuation of pancreatic density of 27 HU, which was lower than that observed in the non-fistula group (33.31 HU). However, statistical analysis did not reveal a significant association between low pancreatic density and fistula development. Therefore, our findings do not establish a significant association between pancreatic fistula and pancreatic density, aligning with the existing literature on the subject.

Keywords

• postoperative pancreatic fistula
• duodenocephalopancreasectomy
• sarcopenia
• pancreas
• CT imaging
• radiology