The Late Phase/Early Phase Ratio of Pancreatic CT Values as a Novel Predictor of Pancreatic Fistula after Distal Pancreatectomy.
distal pancreatectomy
late phase/early phase ratio
pancreatic fistula
Journal
Acta medica Okayama
ISSN: 0386-300X
Titre abrégé: Acta Med Okayama
Pays: Japan
ID NLM: 0417611
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
entrez:
27
8
2020
pubmed:
28
8
2020
medline:
8
6
2021
Statut:
ppublish
Résumé
Post-operative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy (DP). In this retrospective study, we reviewed the data from patients who underwent DP between 2008 and 2019 in our institute to determine whether the late phase/early phase ratio (L/E ratio) by preoperative computed tomography (CT) scan in the pancreas could predict POPF occurrence after DP. We examined the relationship between preoperative or intraoperative factors and the occurrence of POPF after DP using statistical methods in 23 males and 21 females with a mean age of 73. The mean L/E ratio was significantly lower in the POPF group than the non-POPF group (p=0.035). The L/E ratio had moderate diagnostic accuracy, with a calculated optimal cutoff value of 0.77. In univariate analysis, a significant association was noted between POPF and stump thickness ≥ 16.9, body mass index ≥ 27.5, and L/E ratio ≤ 0.77. In the multivariate analysis, the L/E ratio (odds ratio, 5.96; p=0.036) was an independent risk factor for POPF. Our findings suggest that the pancreatic L/E ratio may predict the occurrence of POPF after DP. This measure may be useful in preoperative risk stratification, patient counseling, and perioperative patient management, improving clinical outcomes after DP.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
351-358Déclaration de conflit d'intérêts
No potential conflict of interest relevant to this article was reported.
Références
Zhang H, Zhu F, Shen M, Tian R, Shi CJ, Wang X, Jiang JX, Hu J, Wang M and Qin RY: Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg (2015) 102: 4-15.
Peng YP, Zhu XL, Yin LD, Zhu Y, Wei JS, Wu JL and Miao Y: Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis. Sci Rep (2017) 7: 185
Eshmuminov D, Schneider MA, Tschuor C, Raptis DA, Kambakamba P, Muller X, Lesurtel M and Clavien PA: Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture. HPB (Oxford) (2018) 20: 992-1003.
Kah Heng CA, Salleh I, San TS, Ying F and Su-Ming T: Pancreatic fistula after distal pancreatectomy: incidence, risk factors and management. ANZ J Surg (2010) 80: 619-623.
Dinter DJ, Aramin N, Weiss C, Singer C, Weisser G, Schoenberg SO, Post S and Niedergethmann M: Prediction of anastomotic leakage after pancreatic head resections by dynamic magnetic resonance imaging (dMRI). J Gastrointest Surg (2009) 13: 735-744.
Takahashi N, Fletcher JG, Hough DM, Fidler JL, Kawashima A, Mandrekar JN and Chari ST: Autoimmune pancreatitis: differentiation from pancreatic carcinoma and normal pancreas on the basis of enhancement characteristics at dual-phase CT. AJR Am J Roentgenol (2009) 193: 479-484.
Hashimoto Y, Sclabas GM, Takahashi N, Kirihara Y, Smyrk TC, Huebner M and Farnell MB: Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy. J Gastrointest Surg (2011) 15: 2193-2204.
Yardimci S, Kara YB, Tuney D, Attaallah W, Ugurlu MU, Dulundu E and Yegen SC: A simple method to evaluate whether pancreas texture can be used to predict pancreatic fistula risk after pancreatoduodenectomy. J Gastrointest Surg (2015) 19: 1625-1631.
Sandini M, Bernasconi DP, Ippolito D, Nespoli L, Baini M, Barbaro S, Fior D and Gianotti L: Preoperative computed tomography to predict and stratify the risk of severe pancreatic fistula after pancreatoduodenectomy. Medicine (Baltimore) (2015) 94: e1152.
Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, Rodríguez F and Fernández G: CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp (2005) 20: 38-45.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M and International Study Group on Pancreatic Fistula Definition: Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery (2005) 138: 8-13.
Wellner UF, Kayser G, Lapshyn H, Sick O, Makowiec F, Hoppner J, Theodor U, and Keck Tobias: A simple scoring system based on clinical factors related to pancreatic teture predicts postoperative pancreatic fistula preoperatively. HPB (2010) 12: 696-702
Youden WJ: Index for rating diagnostic tests. Cancer (1950) 3: 32-35.
Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, Rodriguez R, Thayer SP and Fernandez-del Castillo C: Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg (2008) 12: 1691-1698.
Kawai M, Tani M, Okada K, Hirono S, Miyazawa M, Shimizu A, Kitahata Y and Yamaue H: Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy. Am J Surg (2013) 206: 352-359.
Eguchi H, Nagano H, Tanemura M, Takeda Y, Marubashi S, Kobayashi S, Wada H, Umeshita K, Mori M and Doki Y: A thick pancreas is a risk factor for pancreatic fistula after a distal pancreatectomy: selection of the closure technique according to the thickness. Dig Surg (2011) 28: 50-56.
Nakamura M, Shindo K, Ideno N, Ueda J, Takahata S, Nakashima H, Ohtsuka T, Shimizu S, Oda Y and Tanaka M: Prediction of pancreatic fistula by preoperatively assessable factors; retrospective review of unified operations by single surgeon. Hepatogastroenterology (2014) 61: 834-837.
Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, Yamamoto J and Yamaguchi T: Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg (2010) 34: 121-125.
Ban D, Shimada K, Konishi M, Saiura A, Hashimoto M and Uesaka K: Stapler and nonstapler closure of the pancreatic remnant after distal pancreatectomy: multicenter retrospective analysis of 388 patients. World J Surg (2012) 36: 1866-1873.
Subhedar PD, Patel SH, Kneuertz PJ, Maithel SK, Staley CA, Sarmiento JM, Galloway JR and Kooby DA: Risk factors for pancreatic fistula after stapled gland transection. Am Surg (2011) 77: 965-970.
Distler M, Kersting S, Ruckert F, Kross P, Saeger HD, Weitz J and Grutzmann R: Chronic pancreatitis of the pancreatic remnant is an independent risk factor for pancreatic fistula after distal pancreatectomy. BMC Surg (2014) 14: 54.
Kleeff J, Diener MK, ZʼGraggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Muller MW, Friess H and Buchler MW: Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg (2007) 245: 573-582.
Deprez PH: EUS elastography: is it replacing or supplementing tissue acquisition? Gastrointest Endosc (2013) 77: 590-592.
Xu C, Wei S, Xie Y, Guan X, Fu N, Huang P and Yang B: Combined use of the automated breast volume scanner and the US elastography for the differentiation of benign from malignant lesions of the breast. BMC Cancer (2014) 14: 798.
Friess H, Malfertheiner P, Isenmann R, Kuhne H, Beger HG and Buchler MW : The risk of pancreaticointestinal anastomosis can be predicted preoperatively. Pancreas (1996) 13: 202-208.
Pham A and Forsmark C: Chronic pancreatitis: review and update of etiology, risk factors, and management. F1000Res (2018) 7.