Pre-operative prediction of pancreatic fistula: is it possible?
Keith J Roberts1, Rowland Storey, James Hodson
1The Department of Pancreatic Surgery, St James University Hospital, Beckett St, Leeds LS9 7TF, UK. j.k.roberts@bham.ac.uk
Insights
Pre-operative CT scans can predict pancreatic fistula (PF) risk before pancreatoduodenectomy (PD). Wider pancreatic ducts and lower pancreatic density on CT scans are associated with a reduced risk of PF.
Area of Science:
- Surgical Oncology
- Radiology
- Gastroenterology
Background:
- Pancreatic fistula (PF) is a significant complication following pancreatoduodenectomy (PD).
- Predicting PF risk pre-operatively allows for personalized patient management and treatment strategies.
- Existing risk factors are primarily intra-operative, highlighting the need for pre-operative predictive tools.
Purpose of the Study:
- To identify pre-operative factors that can predict the risk of pancreatic fistula (PF) after pancreatoduodenectomy (PD).
- To explore the utility of pre-operative CT imaging in assessing PF risk.
Main Methods:
- Retrospective analysis of 155 patients undergoing PD.
- Pre-operative CT scans were analyzed for pancreatic duct width, gland thickness, and pancreatic density (Hounsfield units).
- Statistical associations between these imaging parameters and the occurrence of PF were investigated.
Main Results:
- PF occurred in 42 of 155 patients.
- An inverse relationship was found between pancreatic duct width and PF risk (OR=0.639 per 1mm increase, p<0.001).
- Pancreatic gland thickness and density at the resection margin were positively associated with PF risk (p=0.03). No patient-specific variables were associated with PF.
Conclusions:
- Pre-operative CT imaging, particularly pancreatic duct width assessed as a continuous variable, can effectively predict PF risk.
- Pancreatic density is a novel, independently associated factor with PF risk.
- Further research is warranted to explore the relationship between pancreatic density, steatosis, and PF.
Background/Objectives:
Understanding a patient's risk of pancreatic fistula (PF) prior to pancreatoduodenectomy (PD) would permit an individualised approach to patient selection, consent and, potentially, treatment. Various intra and post operative factors including pancreatic duct width and steatosis are associated with PF. We sought to identify whether information available in the pre-operative phase can predict PF.
Methods:
Associations between patient characteristics, pre-operative blood test results, data from pre-operative CT imaging and PF were explored. Pancreatic density (Hounsfield units, Hu), pancreatic duct size and gland thickness were measured using CT imaging.
Results:
PF occurred in 42 of 155 cases (types A, B and C: 32, 8, 2 respectively). An inverse relationship between duct width and PF was observed. The odds ratio of PF, for each 1 mm increase in duct width, was 0.639 (95% CI = 0.531-0.769, p < 0.001). The gland thickness and density at the pancreatic resection margin were positively associated with PF (both p = 0.03). No patient variable was associated with PF.
Conclusions:
Pancreatic duct width has previously been assessed at the time of operation and simply regarded as normal or wide. Consideration of duct width as a continuous variable using pre-operative CT imaging can be used to simply predict risk of PF. The association between pancreatic density and PF is a novel finding. Whether pancreatic density in Hu relates to steatosis, as it does for hepatic steatosis, merits further review given the association between pancreatic steatosis and PF.
