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Technical Detail for Robot Assisted Pancreaticoduodenectomy
Published on: September 28, 2019
Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after
Marius Lucian Savin1,2, Florin Mihai1,2, Liliana Gheorghe1,2
1"Gr. T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
Insights
Preoperative CT scans can predict pancreatic fistula after surgery. Morphologic parameters like pancreatic duct caliber and remnant volume help assess risk, improving patient outcomes.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Oncology
Background:
- Postoperative pancreatic fistula (POPF) is a major complication of cephalic pancreatoduodenectomy (CPD).
- POPF leads to increased morbidity, prolonged hospital stays, and higher healthcare costs.
- Accurate prediction of POPF risk is crucial for patient management.
Purpose of the Study:
- To evaluate the utility of preoperative multisequence computed tomography (CT) scan morphologic parameters in predicting clinically relevant postoperative pancreatic fistula (CRPF).
- To develop a risk score based on CT-derived parameters for CRPF prediction using multiple regression analysis.
Main Methods:
- Analysis of preoperative CT scans from 78 patients undergoing CPD.
- Measurement of pancreatic and liver density, main pancreatic duct (MPD) caliber, and estimated pancreatic remnant volume (ERPV).
- Correlation of parameters with CRPF using univariate and logistic regression, with ROC analysis for score validation.
Main Results:
- Significant differences in unenhanced pancreatic density (UPD), delayed pancreatic density, unenhanced liver density (UDL), MPD caliber, and ERPV between CRPF and non-CRPF groups.
- Development of two risk scores using MPD and ERPV, with either UPD or UDL as the third variable.
- Achieved areas under the ROC curve (AUC) of 0.846 and 0.774 for the proposed scores, indicating good predictive accuracy.
Conclusions:
- Preoperative CT imaging is a valuable tool for predicting the risk of CRPF after CPD.
- Incorporating morphologic CT parameters into risk scores can aid in identifying high-risk patients.
- This approach may facilitate personalized perioperative management strategies to mitigate POPF complications.
Abstract:
Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 ± 6.8 HU vs. 50.4 ± 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, p = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, p = 0.02) and ERPV (46.37 ± 10.39 cm3 vs. 34.87 ± 12.35 cm3, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694-0.941) and 0.774 (95% CI 0.599-0.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.
