Format

Send to

Choose Destination
Am J Surg. 2016 May;211(5):871-6. doi: 10.1016/j.amjsurg.2016.02.001. Epub 2016 Feb 23.

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

Author information

1
Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
2
Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
3
Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
4
Virginia Mason Medical Center, Seattle, WA, USA.
5
Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA.
6
Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA. Electronic address: philippa.newell@gmail.com.

Abstract

BACKGROUND:

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.

KEYWORDS:

Distal pancreatectomy; Pancreatic fistula; Risk factors

PMID:
27046794
DOI:
10.1016/j.amjsurg.2016.02.001
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center