Preoperative computed tomography scan to predict pancreatic fistula after distal pancreatectomy using gland and tumor characteristics

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• 作者：Zeljka Jutric ; M.D.^a ; ^b ; W. Cory Johnston ; M.D.^a ; ^b ; Jan Grendar ; M.D. ; M.Sc.^a ; ^b ; Leah Haykin ; B.S.^a ; Connor Mathews ; B.S.^b ; Liv K. Harmon ; M.D.^d ; Jian Shen ; M.D.^b ; Hejin P. Hahn ; M.D. ; Ph.D.^d ; David L. Coy ; M.D. ; Ph.D.^d ; Maria A. Cassera ; B.S.^a ; W. Scott Helton ; M.D.^d ; Flavio G. Rocha ; M.D.^d ; Ronald F. Wolf ; M.D.^a ; ^b ; ^c ; Paul D. Hansen ; M.D.^a ; ^b ; ^c ; Chet W. Hammill ; M.D. ; M.S.^a ; ^b ; ^c ; Adnan A. Alseidi ; M.D.^d ; Pippa H. Newell ; M.D.^a ; ^b ; ^c ; ^{philippa.newell@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Distal pancreatectomy ; Pancreatic fistula ; Risk factors
• 刊名：The American Journal of Surgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：211
• 期：5
• 页码：871-876
• 全文大小：331 K

文摘

Preoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed.

Methods

Risk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120).

Results

Forty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density (P = .0013), but density did not predict pancreatic fistula (P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis.

Conclusions

This multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.