Recent advances on risk prediction of pancreatic fistula following pancreaticoduodenectomy using medical imaging_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUE Yufeng ¹ , HUANG Zixing ¹ , TIAN Bole ² ,  SONG Bin ¹

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

SONG Bin, Email: cjr.songbin@vip.163.com

Keywords：

pancreaticoduodenectomy; pancreatic fistula; risk prediction; medical imaging

DOI：

10.7507/1007-9424.202011057

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the current status and update of the use of medical imaging in risk prediction of pancreatic fistula following pancreaticoduodenectomy (PD).Method A systematic review was performed based on recent literatures regarding the radiological risk factors and risk prediction of pancreatic fistula following PD.Results The risk prediction of pancreatic fistula following PD included preoperative, intraoperative, and postoperative aspects. Visceral obesity was the independent risk factor for clinically relevant postoperative pancreatic fistula (CR-POPF). Radiographically determined sarcopenia had no significant predictive value on CR-POPF. Smaller pancreatic duct diameter and softer pancreatic texture were associated with higher incidence of pancreatic fistula. Besides the surgeons’ subjective intraoperative perception, quantitative assessment of the pancreatic texture based on medical imaging had been reported as well. In addition, the postoperative laboratory results such as drain amylase and serum lipase level on postoperative day 1 could also be used for the evaluation of the risk of pancreatic fistula.Conclusions Risk prediction of pancreatic fistula following PD has considerable clinical significance, it leads to early identification and early intervention of the risk factors for pancreatic fistula. Medical imaging plays an important role in this field. Results from relevant studies could be used to optimize individualized perioperative management of patients undergoing PD.

Citation： YUE Yufeng, HUANG Zixing, TIAN Bole, SONG Bin. Recent advances on risk prediction of pancreatic fistula following pancreaticoduodenectomy using medical imaging. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 115-119. doi: 10.7507/1007-9424.202011057 Copy

1.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
2.	Uzunoglu FG, Reeh M, Vettorazzi E, et al. Preoperative pancreatic resection (PREPARE) score: a prospective multicenter-based morbidity risk score. Ann Surg, 2014, 260(5): 857-864.
3.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
4.	El Amrani M, Vermersch M, Fulbert M, et al. Impact of sarcopenia on outcomes of patients undergoing pancreatectomy: A retrospective analysis of 107 patients. Medicine (Baltimore), 2018, 97(39): e12076.
5.	Sandini M, Bernasconi DP, Ippolito D, et al. Preoperative computed tomography to predict and stratify the risk of severe pancreatic fistula after pancreatoduodenectomy. Medicine (Baltimore), 2015, 94(31): e1152.
6.	Kopljar M, Čoklo M, Krstačić A, et al. Retrorenal fat predicts grade C pancreatic fistula after pancreaticoduodenectomy. ANZ J Surg, 2020 Jul 20. doi: 10.1111/ans.16147.
7.	Tranchart H, Gaujoux S, Rebours V, et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy. Ann Surg, 2012, 256(1): 139-145.
8.	House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg, 2008, 12(2): 270-278.
9.	Park CM, Park JS, Cho ES, et al. The effect of visceral fat mass on pancreatic fistula after pancreaticoduodenectomy. J Invest Surg, 2012, 25(3): 169-173.
10.	Jang M, Park HW, Huh J, et al. Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI. Eur Radiol, 2019, 29(5): 2417-2425.
11.	Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature, 2006, 444(7121): 881-887.
12.	Rega G, Kaun C, Demyanets S, et al. Vascular endothelial growth factor is induced by the inflammatory cytokines interleukin-6 and oncostatin m in human adipose tissue in vitro and in murine adipose tissue in vivo. Arterioscler Thromb Vasc Biol, 2007, 27(7): 1587-1595.
13.	Uchida Y, Masui T, Nakano K, et al. Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery. Br J Surg, 2019, 106(5): 616-625.
14.	de Castro SM, Busch OR, van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg, 2005, 92(9): 1117-1123.
15.	Li Y, Zhou F, Zhu DM, et al. Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol, 2019, 25(21): 2650-2664.
16.	Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1): 1-14.
17.	Yamamoto Y, Sakamoto Y, Nara S, et al. A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2011, 35(12): 2747-2755.
18.	Roberts KJ, Storey R, Hodson J, et al. Pre-operative prediction of pancreatic fistula: is it possible? Pancreatology, 2013, 13(4): 423-428.
19.	Nishida Y, Kato Y, Kudo M, et al. Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy. J Gastrointest Surg, 2016, 20(9): 1586-1594.
20.	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
21.	Peng P, Hyder O, Firoozmand A, et al. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg, 2012, 16(8): 1478-1486.
22.	Amini N, Spolverato G, Gupta R, et al. Impact total psoas volume on short- and long-term outcomes in patients undergoing curative resection for pancreatic adenocarcinoma: a new tool to assess sarcopenia. J Gastrointest Surg, 2015, 19(9): 1593-1602.
23.	Tan BH, Birdsell LA, Martin L, et al. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res, 2009, 15(22): 6973-6979.
24.	Bundred J, Kamarajah SK, Roberts KJ. Body composition assessment and sarcopenia in patients with pancreatic cancer: a systematic review and meta-analysis. HPB (Oxford), 2019, 21(12): 1603-1612.
25.	Onesti JK, Wright GP, Kenning SE, et al. Sarcopenia and survival in patients undergoing pancreatic resection. Pancreatology, 2016, 16(2): 284-289.
26.	Sui K, Okabayshi T, Iwata J, et al. Correlation between the skeletal muscle index and surgical outcomes of pancreaticoduodenectomy. Surg Today, 2018, 48(5): 545-551.
27.	Aubrey J, Esfandiari N, Baracos VE, et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf), 2014, 210(3): 489-497.
28.	van Dijk DP, Bakens MJ, Coolsen MM, et al. Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer. J Cachexia Sarcopenia Muscle, 2017, 8(2): 317-326.
29.	Van Rijssen LB, van Huijgevoort NC, Coelen RJ, et al. Skeletal muscle quality is associated with worse survival after pancreatoduodenectomy for periampullary, nonpancreatic cancer. Ann Surg Oncol, 2017, 24(1): 272-280.
30.	Pausch T, Hartwig W, Hinz U, et al. Cachexia but not obesity worsens the postoperative outcome after pancreatoduodenectomy in pancreatic cancer. Surgery, 2012, 152(3 Suppl 1): S81-S88.
31.	Addeo P, Delpero JR, Paye F, et al. Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association. HPB (Oxford), 2014, 16(1): 46-55.
32.	Kawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective. World J Gastroenterol, 2016, 22(14): 3712-3724.
33.	Dinter DJ, Aramin N, Weiss C, et al. Prediction of anastomotic leakage after pancreatic head resections by dynamic magnetic resonance imaging (dMRI). J Gastrointest Surg, 2009, 13(4): 735-744.
34.	Belyaev O, Rosenkranz S, Munding J, et al. Quantitative assessment and determinants of suture-holding capacity of human pancreas. J Surg Res, 2013, 184(2): 807-812.
35.	Mathur A, Pitt HA, Marine M, et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg, 2007, 246: 1058-1064.
36.	Kim SY, Kim H, Cho JY, et al. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology, 2014, 271(1): 104-112.
37.	马春龙, 韩玮. 胰十二指肠切除术后腹腔引流液淀粉酶水平对B、C级胰瘘预测作用的探讨. 中国普外基础与临床杂志, 2019, 26(8): 939-942.
38.	Israel JS, Rettammel RJ, Leverson GE, et al. Does postoperative drain amylase predict pancreatic fistula after pancreatectomy? J Am Coll Surg, 2014, 218(5): 978-987.
39.	Dalla Valle R, De Bellis M, Pedrazzi G, et al. Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy? Int J Surg, 2015, 21 Suppl 1: S50-S54.

1. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
2. Uzunoglu FG, Reeh M, Vettorazzi E, et al. Preoperative pancreatic resection (PREPARE) score: a prospective multicenter-based morbidity risk score. Ann Surg, 2014, 260(5): 857-864.
3. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
4. El Amrani M, Vermersch M, Fulbert M, et al. Impact of sarcopenia on outcomes of patients undergoing pancreatectomy: A retrospective analysis of 107 patients. Medicine (Baltimore), 2018, 97(39): e12076.
5. Sandini M, Bernasconi DP, Ippolito D, et al. Preoperative computed tomography to predict and stratify the risk of severe pancreatic fistula after pancreatoduodenectomy. Medicine (Baltimore), 2015, 94(31): e1152.
6. Kopljar M, Čoklo M, Krstačić A, et al. Retrorenal fat predicts grade C pancreatic fistula after pancreaticoduodenectomy. ANZ J Surg, 2020 Jul 20. doi: 10.1111/ans.16147.
7. Tranchart H, Gaujoux S, Rebours V, et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy. Ann Surg, 2012, 256(1): 139-145.
8. House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg, 2008, 12(2): 270-278.
9. Park CM, Park JS, Cho ES, et al. The effect of visceral fat mass on pancreatic fistula after pancreaticoduodenectomy. J Invest Surg, 2012, 25(3): 169-173.
10. Jang M, Park HW, Huh J, et al. Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI. Eur Radiol, 2019, 29(5): 2417-2425.
11. Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature, 2006, 444(7121): 881-887.
12. Rega G, Kaun C, Demyanets S, et al. Vascular endothelial growth factor is induced by the inflammatory cytokines interleukin-6 and oncostatin m in human adipose tissue in vitro and in murine adipose tissue in vivo. Arterioscler Thromb Vasc Biol, 2007, 27(7): 1587-1595.
13. Uchida Y, Masui T, Nakano K, et al. Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery. Br J Surg, 2019, 106(5): 616-625.
14. de Castro SM, Busch OR, van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg, 2005, 92(9): 1117-1123.
15. Li Y, Zhou F, Zhu DM, et al. Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol, 2019, 25(21): 2650-2664.
16. Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1): 1-14.
17. Yamamoto Y, Sakamoto Y, Nara S, et al. A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2011, 35(12): 2747-2755.
18. Roberts KJ, Storey R, Hodson J, et al. Pre-operative prediction of pancreatic fistula: is it possible? Pancreatology, 2013, 13(4): 423-428.
19. Nishida Y, Kato Y, Kudo M, et al. Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy. J Gastrointest Surg, 2016, 20(9): 1586-1594.
20. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
21. Peng P, Hyder O, Firoozmand A, et al. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg, 2012, 16(8): 1478-1486.
22. Amini N, Spolverato G, Gupta R, et al. Impact total psoas volume on short- and long-term outcomes in patients undergoing curative resection for pancreatic adenocarcinoma: a new tool to assess sarcopenia. J Gastrointest Surg, 2015, 19(9): 1593-1602.
23. Tan BH, Birdsell LA, Martin L, et al. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res, 2009, 15(22): 6973-6979.
24. Bundred J, Kamarajah SK, Roberts KJ. Body composition assessment and sarcopenia in patients with pancreatic cancer: a systematic review and meta-analysis. HPB (Oxford), 2019, 21(12): 1603-1612.
25. Onesti JK, Wright GP, Kenning SE, et al. Sarcopenia and survival in patients undergoing pancreatic resection. Pancreatology, 2016, 16(2): 284-289.
26. Sui K, Okabayshi T, Iwata J, et al. Correlation between the skeletal muscle index and surgical outcomes of pancreaticoduodenectomy. Surg Today, 2018, 48(5): 545-551.
27. Aubrey J, Esfandiari N, Baracos VE, et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf), 2014, 210(3): 489-497.
28. van Dijk DP, Bakens MJ, Coolsen MM, et al. Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer. J Cachexia Sarcopenia Muscle, 2017, 8(2): 317-326.
29. Van Rijssen LB, van Huijgevoort NC, Coelen RJ, et al. Skeletal muscle quality is associated with worse survival after pancreatoduodenectomy for periampullary, nonpancreatic cancer. Ann Surg Oncol, 2017, 24(1): 272-280.
30. Pausch T, Hartwig W, Hinz U, et al. Cachexia but not obesity worsens the postoperative outcome after pancreatoduodenectomy in pancreatic cancer. Surgery, 2012, 152(3 Suppl 1): S81-S88.
31. Addeo P, Delpero JR, Paye F, et al. Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association. HPB (Oxford), 2014, 16(1): 46-55.
32. Kawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective. World J Gastroenterol, 2016, 22(14): 3712-3724.
33. Dinter DJ, Aramin N, Weiss C, et al. Prediction of anastomotic leakage after pancreatic head resections by dynamic magnetic resonance imaging (dMRI). J Gastrointest Surg, 2009, 13(4): 735-744.
34. Belyaev O, Rosenkranz S, Munding J, et al. Quantitative assessment and determinants of suture-holding capacity of human pancreas. J Surg Res, 2013, 184(2): 807-812.
35. Mathur A, Pitt HA, Marine M, et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg, 2007, 246: 1058-1064.
36. Kim SY, Kim H, Cho JY, et al. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology, 2014, 271(1): 104-112.
37. 马春龙, 韩玮. 胰十二指肠切除术后腹腔引流液淀粉酶水平对B、C级胰瘘预测作用的探讨. 中国普外基础与临床杂志, 2019, 26(8): 939-942.
38. Israel JS, Rettammel RJ, Leverson GE, et al. Does postoperative drain amylase predict pancreatic fistula after pancreatectomy? J Am Coll Surg, 2014, 218(5): 978-987.
39. Dalla Valle R, De Bellis M, Pedrazzi G, et al. Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy? Int J Surg, 2015, 21 Suppl 1: S50-S54.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Recent advances on risk prediction of pancreatic fistula following pancreaticoduodenectomy using medical imaging

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