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Updated: Jan 14, 2026
Colonial Wig Pancreaticojejunostomy
Published on: March 12, 2019
A novel preoperative risk score based on computed tomography morphometrics for predicting clinically relevant
O Usenko1, O Symonov1, E Prysyazhnyuk1
1National Scientific Center of Surgery and Transplantology named after O.O. Shalimov, Kyiv, Ukraine.
Insights
A new scoring system uses preoperative CT scans to predict the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). This tool allows for better surgical planning and aims to reduce complications.
Area of Science:
- Surgical Oncology
- Radiology
- Gastroenterology
Background:
- Clinically relevant postoperative pancreatic fistula (CR-POPF) is a frequent and serious complication after pancreatoduodenectomy (PD).
- Current risk stratification relies on intraoperative models, lacking objective preoperative tools.
- There is a need for reliable preoperative methods to assess CR-POPF risk.
Purpose of the Study:
- To develop and validate a preoperative scoring system for predicting CR-POPF risk after PD.
- To utilize objective and reproducible parameters from preoperative CT scans.
- To enable individualized surgical planning and prophylactic strategies.
Main Methods:
- Retrospective analysis of 234 patients undergoing PD.
- Preoperative multiphase contrast-enhanced CT was used to measure pancreatic parenchymal attenuation, duct-to-parenchyma (D/P) ratios, main pancreatic duct diameter, and BMI.
- A 6-point scoring system was developed using logistic regression and ROC analysis.
Main Results:
- Significant associations found between low pancreatic attenuation (≤30 HU), low D/P ratio (≤0.2), small duct diameter (<3 mm), and high BMI (≥25 kg/m²) with CR-POPF.
- The 6-point score demonstrated high accuracy (AUC 0.89, sensitivity 81.8%, specificity 91.7%).
- CR-POPF incidence varied significantly across risk groups (4.6% to 82.5%) and correlated with fistula severity.
Conclusions:
- The proposed model offers a fully preoperative, quantitative risk assessment for CR-POPF using objective CT-based parameters.
- Implementation can lead to personalized surgical planning and targeted prophylactic measures.
- Further validation in prospective and external cohorts is ongoing.
Background:
Clinically relevant postoperative pancreatic fistula (CR-POPF) remains one of the most serious and frequent complications after pancreatoduodenectomy (PD), leading to prolonged hospital stay, increased costs, and higher mortality. Despite numerous intraoperative risk models, there is a lack of objective, reproducible, and fully preoperative tools for reliable risk stratification.
Methods:
This retrospective study included 234 patients who underwent PD. Preoperative multiphase contrast-enhanced computed tomography (including noncontrast native phase) was used to measure pancreatic parenchymal attenuation, ventrodorsal and craniocaudal duct-to-parenchyma (D/P) ratios, main pancreatic duct diameter, and body mass index (BMI). A 6-point scoring system was constructed based on multivariate logistic regression and receiver operating characteristic (ROC) curve analysis. Patients were classified into 4 risk groups.
Results:
Pancreatic attenuation of ≤30 Hounsfield units, D/P ratio of ≤0.2, duct diameter of <3 mm, and BMI of ≥25 kg/m² were significantly associated with CR-POPF. The combined 6-point score achieved an area under the ROC curve of 0.89, with a sensitivity of 81.8% and a specificity of 91.7%. POPF incidence ranged from 4.6% in low-risk to 82.5% in very-high-risk patients. The scoring system also correlated with the severity of the fistula. Baseline incidence of CR-POPF (International Study Group of Pancreatic Surgery grade B/C) was 18.8% in this cohort.
Conclusion:
The proposed model enables fully preoperative, quantitative risk assessment of CR-POPF using objective and widely available parameters. Its implementation allows for individualized surgical planning and targeted prophylactic strategies, potentially improving postoperative outcomes and reducing complication rates after PD. The model is currently undergoing internal validation in a prospective cohort, whereas external validation remains necessary.
