Risk Prediction of Postoperative Pancreatic Fistula After Open Pancreatoduodenectomy Using Objective Indicators...

Area of Science:

• Abdominal Radiology
• Surgical Oncology
• Gastroenterology

Background:

• Postoperative pancreatic fistula (POPF) is a significant complication after pancreatoduodenectomy (PD).
• Accurate prediction of clinically relevant POPF (CR-POPF) is crucial for mitigating patient morbidity.
• Identifying objective preoperative risk factors can enhance patient outcomes.

Purpose of the Study:

• To identify significant predictive risk factors for CR-POPF.
• To evaluate the utility of preoperative imaging parameters in predicting CR-POPF.
• To establish objective markers for CR-POPF risk assessment.

Main Methods:

• Retrospective analysis of 143 patients undergoing PD.
• Measurement of main pancreatic duct diameter, peritoneum-to-pancreas distance (PTP), and abdominal wall thickness (AWT) from CT/MRCP.
• Calculation of PTP/AWT ratio (visceral-to-subcutaneous fat ratio) and liver-to-pancreas attenuation ratio (L/E ratio).

Main Results:

• CR-POPF occurred in 33 (23.1%) patients.
• Multivariable analysis identified a visceral-to-subcutaneous fat ratio ≥ 3.5 (OR: 3.55) as a risk predictor.
• A liver-to-pancreas attenuation ratio < 1.2 (OR: 6.07) was also identified as an independent risk predictor for CR-POPF.

Conclusions:

• Objective parameters from preoperative CT or MRCP can effectively predict CR-POPF.
• These simple imaging markers aid in accurate risk assessment.
• Early identification of high-risk patients can lead to timely interventions and improved postoperative outcomes.