The attenuation value of preoperative computed tomography as a novel predictor for pancreatic fistula after pancreaticoduodenectomy

• Published in: Surgery today (Tokyo, Japan) Vol. 48; no. 6; pp. 598 - 608
• Main Authors: Hanaki, Takehiko, Uejima, Chihiro, Amisaki, Masataka, Yosuke, Arai, Tokuyasu, Naruo, Honjo, Soichiro, Sakamoto, Teruhisa, Saito, Hiroaki, Ikeguchi, Masahide, Fujiwara, Yoshiyuki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-06-2018
• Subjects: Aged; Aged, 80 and over; Amylases - metabolism; Biomarkers - metabolism; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Original Article; Pancreas - diagnostic imaging; Pancreatic Fistula - diagnosis; Pancreatic Fistula - diagnostic imaging; Pancreatic Fistula - etiology; Pancreatic Fistula - metabolism; Pancreaticoduodenectomy; Parenchymal Tissue - diagnostic imaging; Perioperative Care; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Risk Factors; Surgery; Surgical Oncology; Tomography, X-Ray Computed; Pancreaticoduodenectomy; Computed tomography; Pancreatic fistula; Attenuation value
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-018-1626-y

Purpose
Pancreatic fistula (PF) is the most serious complication following pancreaticoduodenectomy (PD). This study was performed to identify new clinical factors that may predict the development of PF after PD to improve perioperative management.
Methods
Seventy-five consecutive patients who underwent PD from 2012 to 2015 were evaluated. The patients’ perioperative data including the computed tomography (CT) parameters were collected. The minimum, maximum, and mean CT attenuation values (HU
min
, HU
max
, and HU
mean
, respectively) were extracted from the pancreatic parenchyma (≥ 100 pixels), and the standard deviation of these values (HU
SD
) was determined from the slice in which the superior mesenteric and splenic veins were merged. PF was defined as grade B or C according to the International Study Group for Pancreatic Fistula criteria.
Results
The PF occurrence rate (grade B or C) was 25.3% in 75 patients. A multivariate analysis identified a larger HU
SD
(odds ratio 3.092; 95% CI 1.018–9.394) and higher amylase concentration in drainage fluid on postoperative day 1 (odds ratio 1.0001; 95% CI 1.00001–1.00022) as significant risk factors for PF.
Conclusions
The HU
SD
of preoperative CT attenuation values in the pancreatic parenchyma was found to be an independent predictor for PF after PD and it might therefore positively contribute to the perioperative management of PD.