Preoperative computed tomography scan to predict pancreatic fistula after distal pancreatectomy using gland and tumor characteristics

• Published in: The American journal of surgery Vol. 211; no. 5; pp. 871 - 876
• Main Authors: Jutric, Zeljka, M.D, Johnston, W. Cory, M.D, Grendar, Jan, M.D., M.Sc, Haykin, Leah, B.S, Mathews, Connor, B.S, Harmon, Liv K., M.D, Shen, Jian, M.D, Hahn, Hejin P., M.D., Ph.D, Coy, David L., M.D., Ph.D, Cassera, Maria A., B.S, Helton, W. Scott, M.D, Rocha, Flavio G., M.D, Wolf, Ronald F., M.D, Hansen, Paul D., M.D, Hammill, Chet W., M.D., M.S, Alseidi, Adnan A., M.D, Newell, Pippa H., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2016; Elsevier Limited
• Subjects: Adult; Aged; Biopsy, Needle; Body mass index; Cohort Studies; Confidence intervals; Decision trees; Diabetes; Distal pancreatectomy; Female; Histology; Humans; Immunohistochemistry; Male; Medical imaging; Middle Aged; Mortality; Pancreas; Pancreas - pathology; Pancreas - surgery; Pancreatectomy - adverse effects; Pancreatectomy - methods; Pancreatic fistula; Pancreatic Fistula - etiology; Pancreatic Fistula - physiopathology; Pancreatic Fistula - surgery; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Postoperative Complications - diagnosis; Postoperative Complications - surgery; Postoperative period; Predictive Value of Tests; Preoperative Care - methods; Prognosis; Retrospective Studies; Risk Adjustment; Risk factors; ROC Curve; Studies; Surgery; Survival Rate; Tomography, X-Ray Computed - methods; Treatment Outcome; Variables; Pancreatic fistula; Distal pancreatectomy; Risk factors
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2016.02.001

Abstract Background Preoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed. Methods Risk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120). Results Forty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density ( P = .0013), but density did not predict pancreatic fistula ( P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis. Conclusions This multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.