Preoperative Pancreas CT/MRI Characteristics Predict Fistula Rate after Pancreaticoduodenectomy

Background Pancreatic fistula (PF) is considered to be the main cause of morbidity after pancreaticoduodenectomy (PD). A recent study from our institution suggested the risk for pancreatic fistula after distal pancreatectomy to be closely related to the pancreatic remnant volume (PRV). The hypothesi...

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Bibliographic Details
Published in:World journal of surgery 2012-08, Vol.36 (8), p.1858-1865
Main Authors: Frozanpor, F., Loizou, L., Ansorge, C., Segersvärd, R., Lundell, L., Albiin, N.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Cardiac Surgery
Chi-Square Distribution
Contrast Media
Distal Pancreatectomy
Female
General Surgery
Humans
Logistic Models
Magnetic Resonance Imaging
Magnetic Resonance Imaging Image
Main Pancreatic Duct
Male
Medicin och hälsovetenskap
Medicine
Medicine & Public Health
Pancreatic Fistula
Pancreatic Fistula - diagnosis
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Postoperative Complications - diagnosis
Predictive Value of Tests
Risk Factors
Superior Mesenteric Vein
Surgery
Thoracic Surgery
Tomography, X-Ray Computed
Vascular Surgery
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Summary:Background Pancreatic fistula (PF) is considered to be the main cause of morbidity after pancreaticoduodenectomy (PD). A recent study from our institution suggested the risk for pancreatic fistula after distal pancreatectomy to be closely related to the pancreatic remnant volume (PRV). The hypothesis was formulated that after PD the PRV is an important determinant of the risk for PF formation. Method All patients undergoing PD between September 2007 and November 2010 at the Karolinska University Hospital Stockholm were included. Preoperative multidetector computed tomography (CT) or magnetic resonance imaging (MRI) was used to calculate the PRV and the pancreatic duct width (PDW) at the alleged resection line. Results A total of 182 patients (median age 67 years) undergoing PD were included. The diagnosis was malignant in 144 patients (79.1 %) and benign in 38 (20.9 %). Pancreatic fistula defined according to the International Study Group on Pancreatic Fistula (ISGPF) criteria was diagnosed in 37 patients (20.3 %). The median PRV was 35.2 cm 3 and the median PDW was 3.9 mm. In a univariate analysis a large calculated volume of the pancreatic remnant increased the subsequent risk of PF (odds ratio [OR], 3.71; 95% confidence interval [95% CI], 1.58–8.71; P  
ISSN:0364-2313
1432-2323
1432-2323
DOI:10.1007/s00268-012-1567-3