Pancreatic Duct Diameter and Pancreatic Gland Thickness Measured Using Preoperative CT Imaging in Predicting Pancreatic Fistula Following Pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WUMing-peng ¹ , ZHANGXiao ² , LIUXi-jiao ¹ , HUANGZixing ¹ ,  SONGBin ¹

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of CT/MRI, Leshan People's Hospital, Leshan 614000, Sichuan Province, China;

Corresponding author：

SONGBin, Email: cjr.songbin@vip.163.com

Keywords：

Pancreaticoduodenectomy; Pancreatic fistula; Tomography; X-ray computed

DOI：

10.7507/1007-9424.20140245

Video：

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Objective To evaluate the predictive value of pancreatic duct diameter and pancreatic gland thickness measured using preoperative CT imaging on pancreatic fistula(PF)following pancreaticoduodenectomy (PD). Methods One hundred and fifty-one patients who underwent PD consecutively from January 2013 to April 2014 were reviewed retrospectively. Associations between the gender, age and the pancreatic duct diameter and pancreatic gland thickness from preoperative CT imaging and PF were analyzed. The diagnostic values of the pancreatic duct diameter and pancreatic gland thickness in patients with PF were evaluate by receiver operating characteristic (ROC) analysis. The reliability analysis was done for the pancreatic duct diameter and pancreatic gland thickness by using the intraclass correlation coefficient (ICC). The Spearman rank correlation analysis was done between the pancreatic duct diameter and pancreatic gland thickness. Results ①PF occurred in 46 cases (30.1%).②The gender and age were not associated with PF (Gender: χ²=1.698, P=0.193; Age: χ²=0.016, P=0.900). The pancreatic duct diameter and pancreatic gland thickness were associated with PF (Pancreatic duct diameter: OR=0.275, 95% CI 0.164-0.461, P=0.000; Pancreatic gland thickness: OR=1.319, 95% CI 1.163-1.496, P=0.000).③There was no correlation between the pancreatic duct diameter and the pancreatic gland thickness (r_s=-0.120, P=0.145).④The area under curve of ROC was 0.814 (95% CI 0.745-0.883, P < 0.001) for the pancreatic duct diameter in predicting the PF, the sensitivity and specificity was 68.6% and 78.3% respectively when the best critical value was 3.5 mm. The area under curve of ROC was 0.762 (95% CI 0.674-0.849, P < 0.001) for the pancreatic gland thickness in predicting PF, the sensitivity and specificity was 63.0% and 85.7% respectively when the best critical value was 31 mm.⑤The ICC of the pancreatic duct diameter and pancreatic gland thickness was 0.984 and 0.992 respectively by two medical diagnostic measurement. Conclusion Pancreatic duct diameter and pancreatic gland thickness measured using preoperative CT imaging might be useful in predicting PF following PD.

Citation： WUMing-peng, ZHANGXiao, LIUXi-jiao, HUANGZixing, SONGBin. Pancreatic Duct Diameter and Pancreatic Gland Thickness Measured Using Preoperative CT Imaging in Predicting Pancreatic Fistula Following Pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 1019-1023. doi: 10.7507/1007-9424.20140245 Copy

1.	Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy:incidence, significance, and management[J]. Am J Surg, 1994, 168(4):295-298.
2.	Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications, and outcomes[J]. Ann Surg, 1997, 226(3): 248-260.
3.	Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancreatic fistula after pancreatic head resection[J]. Arch Surg, 1998, 133(10):1094-1098.
4.	Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial[J]. Ann Surg, 2000, 232(3):419-429.
5.	Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer:A single-institution experience[J]. J Gastrointest Surg, 2006, 10(9):1199-1211.
6.	McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy:A national perspective[J]. Ann Surg, 2007, 246(2):246-253.
7.	Schmidt CM, Turrini O, Parikh P, et al. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy:a single-institution experience[J]. Arch Surg, 2010, 145(7):634-640.
8.	Aroori S, Puneet P, Bramhall SR, et al. Outcomes comparing a pancreaticogastrostomy (PG) and a pancreaticojejunostomy (PJ) after a pancreaticoduodenectomy (PD)[J]. HPB (Oxford), 2011, 13(10):723-731.
9.	Hashimoto Y, Sclabas GM, Takahashi N, et al. Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy[J]. J Gastrointest Surg, 2011, 15(12):2193-2204.
10.	Tranchart H, Gaujoux S, Rebours V, et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy[J]. Ann Surg, 2012, 256(1): 139-145.
11.	Frozanpor F, Loizou L, Ansorge C, et al. Preoperative pancreas CT/MRI characteristics predict fistula rate after pancreaticoduodenectomy[J]. World J Surg, 2012, 36(8):1858-1865.
12.	Roberts KJ, Storey R, Hodson J, et al. Pre-operative prediction of pancreatic fistula:is it possible?[J]. Pancreatology, 2013, 13(4):423-428.
13.	Frozanpor F, Loizou L, Ansorge C, et al. Correlation between preoperative imaging and intraoperative risk assessment in the prediction of postoperative pancreatic fistula following pancreatoduodenectomy[J]. World J Surg, 2014 Apr 8.[Epub ahead of print].
14.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1):8-13.
15.	刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[J].中国普外基础与临床杂志, 2008, 15(3):195-200.
16.	席鹏程, 时开网, 杨坤兴.胰管内径对胰十二指肠切除术后胰瘘发生率的影响[J].中国普外基础与临床杂志, 2009, 16(8): 609-612.
17.	潘凡, 江艺, 张小进, 等.胰十二指肠切除术后胰瘘的多因素分析[J].临床肝胆病杂志, 2012, 28(8):587-588, 602.
18.	Gaujoux S, Cortes A, Couvelard A, et al. Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy[J]. Surgery, 2010, 148(1):15-23.
19.	Mathur A, Pitt HA, Marine M, et al. Fatty pancreas:a factor in postoperative pancreatic fistula[J]. Ann Surg, 2007, 246(6): 1058-1064.
20.	Duffas JP, Suc B, Msika S, et al. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy[J]. Am J Surg, 2005, 189(6): 720-729.
21.	杨孙虎, 黄明哲, 李峰, 等.胰十二指肠切除术后腹内并发症和手术死亡的影响因素分析[J].中国普外基础与临床杂志, 2014, 21(3):313-317.

1. Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy:incidence, significance, and management[J]. Am J Surg, 1994, 168(4):295-298.
2. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications, and outcomes[J]. Ann Surg, 1997, 226(3): 248-260.
3. Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancreatic fistula after pancreatic head resection[J]. Arch Surg, 1998, 133(10):1094-1098.
4. Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial[J]. Ann Surg, 2000, 232(3):419-429.
5. Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer:A single-institution experience[J]. J Gastrointest Surg, 2006, 10(9):1199-1211.
6. McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy:A national perspective[J]. Ann Surg, 2007, 246(2):246-253.
7. Schmidt CM, Turrini O, Parikh P, et al. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy:a single-institution experience[J]. Arch Surg, 2010, 145(7):634-640.
8. Aroori S, Puneet P, Bramhall SR, et al. Outcomes comparing a pancreaticogastrostomy (PG) and a pancreaticojejunostomy (PJ) after a pancreaticoduodenectomy (PD)[J]. HPB (Oxford), 2011, 13(10):723-731.
9. Hashimoto Y, Sclabas GM, Takahashi N, et al. Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy[J]. J Gastrointest Surg, 2011, 15(12):2193-2204.
10. Tranchart H, Gaujoux S, Rebours V, et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy[J]. Ann Surg, 2012, 256(1): 139-145.
11. Frozanpor F, Loizou L, Ansorge C, et al. Preoperative pancreas CT/MRI characteristics predict fistula rate after pancreaticoduodenectomy[J]. World J Surg, 2012, 36(8):1858-1865.
12. Roberts KJ, Storey R, Hodson J, et al. Pre-operative prediction of pancreatic fistula:is it possible?[J]. Pancreatology, 2013, 13(4):423-428.
13. Frozanpor F, Loizou L, Ansorge C, et al. Correlation between preoperative imaging and intraoperative risk assessment in the prediction of postoperative pancreatic fistula following pancreatoduodenectomy[J]. World J Surg, 2014 Apr 8.[Epub ahead of print].
14. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1):8-13.
15. 刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[J].中国普外基础与临床杂志, 2008, 15(3):195-200.
16. 席鹏程, 时开网, 杨坤兴.胰管内径对胰十二指肠切除术后胰瘘发生率的影响[J].中国普外基础与临床杂志, 2009, 16(8): 609-612.
17. 潘凡, 江艺, 张小进, 等.胰十二指肠切除术后胰瘘的多因素分析[J].临床肝胆病杂志, 2012, 28(8):587-588, 602.
18. Gaujoux S, Cortes A, Couvelard A, et al. Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy[J]. Surgery, 2010, 148(1):15-23.
19. Mathur A, Pitt HA, Marine M, et al. Fatty pancreas:a factor in postoperative pancreatic fistula[J]. Ann Surg, 2007, 246(6): 1058-1064.
20. Duffas JP, Suc B, Msika S, et al. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy[J]. Am J Surg, 2005, 189(6): 720-729.
21. 杨孙虎, 黄明哲, 李峰, 等.胰十二指肠切除术后腹内并发症和手术死亡的影响因素分析[J].中国普外基础与临床杂志, 2014, 21(3):313-317.

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Pancreatic Duct Diameter and Pancreatic Gland Thickness Measured Using Preoperative CT Imaging in Predicting Pancreatic Fistula Following Pancreaticoduodenectomy

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