Preoperative Pancreas CT/MRI Characteristics Predict Fistula Rate After Pancreaticoduodenectomy

Farshad Frozanpor, PhD, L Loizou, MD, C Ansorge, MD, R Segersvärd, PhD, L Lundell, PhD, N Albiin, PhD. Department of Clinical Science and Education and Department of Clinical Science, Intervention and Technology


Background: Pancreatic fistula (PF) is considered to be the main cause of morbidity after pancreaticoduodenectomy (PD). A recent study from our institution suggested the risk for pancreatic fistula after distal pancreatectomy to be closely related to the pancreatic remnant volume (PRV). The hypothesis was formulated that also after PD the PRV is an important determinant of the risk for PF formation. Method: All patients undergoing PD between September 2007 and November 2010 at the Karolinska University Hospital were included. Preoperative CT or MRI was used to calculate the PRV and the pancreatic duct width (PDW) at the alleged resection line. Results: 182 patients (mean age 65.8) undergoing PD were included. The diagnosis was malignant in 144 patients (79.1%) and benign in 38 (20.9%). PF defined according to the ISGPF criteria was diagnosed in 37 (20.3%) patients. The median PRV after PD was 35.2 (± SD 15.5) cm3 and the median PDW was found to be 3.9 (± SD 3.0) mm. Based on the median value in a univariate risk factor analysis revealed that a large calculated volume of the pancreatic remnant increased the subsequent risk of PF (OR, 3.712; CI, 1.582–8.710; P = 0.003), as did a small duct width (OR, 8.459; 95% CI, 3.106-23.04; P = 0.001). The size of the pancreatic remnant and width of the pancreatic duct maintained their impact on leakage risk also after a multivariate analysis. Conclusion: A large pancreatic remnant volume and small duct increase the risk of pancreatic fistula. Preoperative CT and/or MRI therefore provide a useful instrument for predicting fistula formation before PD.

Session Number: SS03 – HPB (Hepatobiliary and Pancreas)
Program Number: S016

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