Preoperative computed tomography scan to predict pancreatic fistula after distal pancreatectomy using gland and tumor characteristics This article will be presented at the North Pacific Surgical Association.

Zeljka Jutric, W. Cory Johnston, Jan Grendar, Leah Haykin, Connor Mathews, Liv K. Harmon, Jian Shen, Hejin P. Hahn, David L. Coy, Maria A. Cassera, W. Scott Helton, Flavio G. Rocha, Ronald F. Wolf, Paul D. Hansen, Chet W. Hammill, Adnan A. Alseidi, Pippa H. Newell

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)871-876
Number of pages6
JournalAmerican journal of surgery
Volume211
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

Keywords

  • Distal pancreatectomy
  • Pancreatic fistula
  • Risk factors

ASJC Scopus subject areas

  • Surgery

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