A High Abdominal Aortic Calcification Score on CT is a Risk Factor for Postoperative Pancreatic Fistula in Elderly Patients Undergoing Pancreaticoduodenectomy

• Published in: World journal of surgery 2018-04, Vol.42 (4), p.1129-1137
• Main Authors: Kakizawa, Nao, Noda, Hiroshi, Watanabe, Fumiaki, Ichida, Kosuke, Suzuki, Koichi, Rikiyama, Toshiki
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aorta; Arteriosclerosis; Atherosclerosis; Body mass; Calcification; Calcification (ectopic); Cardiac Surgery; Fistula; Fistulae; General Surgery; Geriatrics; Medicine; Medicine & Public Health; Older people; Original Scientific Report; Pancreas; Pancreaticoduodenectomy; Parenchyma; Patients; Postoperative period; Risk analysis; Risk factors; Serum albumin; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4240-z

Background To evaluate the clinical significance of a CT-based evaluation of abdominal aortic calcification (AAC) in the postoperative outcomes after pancreaticoduodenectomy (PD) in elderly patients. Methods Patients 70 years of age and older who were randomly assigned to Group A were compared with those younger than 70 who were assigned to Group B in terms of preoperative and intraoperative variables and postoperative outcomes. We compared the patients with clinically relevant postoperative pancreatic fistula (CR-POPF) (Group C) to those without CR-POPF (Group D), and especially Group A. We also compared the patients with CR-POPF (Group E) to those without CR-POPF (Group E) to clarify the risk factors for POPF, in each of the analyses. The AAC score was determined using the methods of Agatston et al. Results Group A more often had frequent atherosclerosis-related comorbidities (62.2%), low serum albumin (55.9%), and a high AAC score (66.1%). There were no significant differences in the postoperative variables. The comparisons between Groups C and D identified four independent risk factors for CR-POPF: BMI ≥ 25 (OR 8.54, 95% CI 3.15–23.1), male gender (OR 3.17, 95% CI 1.28–7.85), soft pancreatic parenchyma (OR 3.43, 95% CI 1.34–8.81), and the absence of MPD dilatation (OR 5.70, 95% CI 2.13–15.3). Comparisons between Groups E and F identified two independent risk factors for CR-POPF: BMI ≥ 25 (OR 29.4, 95% CI 5.77–150) and a high ACC score (OR 10.8, 95% CI 2.08–56.6). Conclusions We demonstrated, for the first time, that a high AAC score is a risk factor of CR-POPF in elderly patients who underwent PD.