Ann Hepatobiliary Pancreat Surg.  2022 May;26(2):184-189. 10.14701/ahbps.21-145.

The effect of atrophied pancreas as shown in the preoperative imaging on the leakage rate after pancreaticoduodenectomy

Affiliations
  • 1Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  • 2Department of Surgery, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  • 3Department of Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • 4Department of Gastroenterology and Liver Diseases, Hadassah Medical Center, Jerusalem, Israel
  • 5Department of Radiology and Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

Abstract

Backgrounds/Aims
The soft texture of the pancreas parenchyma may inf luence the incidence of pancreatic leakage after pancreaticoduodenectomy (PD). One possible method to assess pancreatic texture and atrophy, is via computed tomography (CT) scan of the abdomen. The purpose of our study was to evaluate the relation between the preoperative CT scan and the incidence of pancreatic fistula after PD.
Methods
A retrospective single-center study including patients who underwent PD for a benign and malignant tumor of the periampullary region between the years 2000 and 2016. Demographic and imaging data were analysed and a correlation with the post-operative leak was evaluated.
Results
Pancreatic leak was documented in 34 out of 154 (22.1%) patients. All the leakage cases occurred in the preserved pancreas group (33.1% of the total preserved pancreas group alone). No leak was documented in the atrophic pancreas group. This difference between the two groups was found to be statistically significant (p ≤ 0.00001).
Conclusions
Atrophic pancreas in the preoperative CT scan may be protective against leakage after PD. These findings may help the surgeon to risk stratify patients accordingly. In addition, the findings suggest that patients with a preserved pancreas may require more protective methods to prevent leakage.

Keyword

Atrophy; Pancreatic fistula; Pancreaticoduodenectomy; Anastomotic leak

Figure

  • Fig. 1 Axial computed tomography shows intact pancreatic architecture (A) and axial tomography (B) showed atrophic pancreas.

  • Fig. 2 The study cohort.


Reference

1. Pallisera A, Morales R, Ramia JM. 2014; Tricks and tips in pancreatoduodenectomy. World J Gastrointest Oncol. 6:344–350. DOI: 10.4251/wjgo.v6.i9.344. PMID: 25232459. PMCID: PMC4163732.
Article
2. Whipple AO. 1945; Pancreaticoduodenectomy for islet carcinoma: a five-year follow-up. Ann Surg. 121:847–852. DOI: 10.1097/00000658-194506000-00008. PMID: 17858621. PMCID: PMC1618156.
3. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. 1993; One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 217:430–435. discussion 435–438. DOI: 10.1097/00000658-199305010-00002. PMID: 8098202. PMCID: PMC1242815.
Article
4. Trede M, Schwall G. 1988; The complications of pancreatectomy. Ann Surg. 207:39–47. DOI: 10.1097/00000658-198801000-00009. PMID: 3276272. PMCID: PMC1493257.
Article
5. Strasberg SM, Drebin JA, Soper NJ. 1997; Evolution and current status of the Whipple procedure: an update for gastroenterologists. Gastroenterology. 113:983–994. DOI: 10.1016/S0016-5085(97)70195-1. PMID: 9287993.
Article
6. Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. 2005; Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol. 11:2456–2461. DOI: 10.3748/wjg.v11.i16.2456. PMID: 15832417. PMCID: PMC4305634.
Article
7. Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, et al. 2007; Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg. 246:1058–1064. DOI: 10.1097/SLA.0b013e31814a6906. PMID: 18043111.
8. Bartholomew LG, Baggenstoss AH, Morlock CG, Comfort MW. 1959; Primary atrophy and lipomatosis of the pancreas. Gastroenterology. 36:563–572. DOI: 10.1016/S0016-5085(59)80023-8. PMID: 13653276.
Article
9. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. 2005; Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 138:8–13. DOI: 10.1016/j.surg.2005.05.001. PMID: 16003309.
Article
10. Felix K, Schuck A, Gaida MM, Hinz U, Dovzhanskiy D, Werner J. 2014; Objective parameters aid the prediction of fistulas in pancreatic surgery. Exp Ther Med. 8:719–726. DOI: 10.3892/etm.2014.1829. PMID: 25120588. PMCID: PMC4113644.
Article
11. Kim Z, Kim MJ, Kim JH, Jin SY, Kim YB, Seo D, et al. 2009; Prediction of post-operative pancreatic fistula in pancreaticoduodenectomy patients using pre-operative MRI: a pilot study. HPB (Oxford). 11:215–221. DOI: 10.1111/j.1477-2574.2009.00011.x. PMID: 19590650. PMCID: PMC2697900.
Article
12. Frozanpor F, Loizou L, Ansorge C, Lundell L, Albiin N, Segersvärd R. 2014; Correlation between preoperative imaging and intraoperative risk assessment in the prediction of postoperative pancreatic fistula following pancreatoduodenectomy. World J Surg. 38:2422–2429. DOI: 10.1007/s00268-014-2556-5. PMID: 24711156.
Article
13. Hong W, Ha HI, Lee JW, Lee SM, Kim MJ. 2019; Measurement of pancreatic fat fraction by CT histogram analysis to predict pancreatic fistula after pancreaticoduodenectomy. Korean J Radiol. 20:599–608. DOI: 10.3348/kjr.2018.0557. PMID: 30887742. PMCID: PMC6424834.
Article
14. Yadav D, Lowenfels AB. 2013; The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 144:1252–1261. DOI: 10.1053/j.gastro.2013.01.068. PMID: 23622135. PMCID: PMC3662544.
Article
15. Hausmann S, Kong B, Michalski C, Erkan M, Friess H. 2014; The role of inflammation in pancreatic cancer. Adv Exp Med Biol. 816:129–151. DOI: 10.1007/978-3-0348-0837-8_6. PMID: 24818722.
Article
16. Meckler KA, Brentnall TA, Haggitt RC, Crispin D, Byrd DR, Kimmey MB, et al. 2001; Familial fibrocystic pancreatic atrophy with endocrine cell hyperplasia and pancreatic carcinoma. Am J Surg Pathol. 25:1047–1053. DOI: 10.1097/00000478-200108000-00009. PMID: 11474289.
Article
17. Del Chiaro M, Segersvärd R, Lohr M, Verbeke C. 2014; Early detection and prevention of pancreatic cancer: is it really possible today? World J Gastroenterol. 20:12118–12131. DOI: 10.3748/wjg.v20.i34.12118. PMID: 25232247. PMCID: PMC4161798.
Article
18. Hruban RH, Maitra A, Goggins M. 2008; Update on pancreatic intraepithelial neoplasia. Int J Clin Exp Pathol. 1:306–316. DOI: 10.1007/978-0-387-69252-4_3. PMID: 18787611. PMCID: PMC2480542.
19. Chu LC, Goggins MG, Fishman EK. 2017; Diagnosis and detection of pancreatic cancer. Cancer J. 23:333–342. DOI: 10.1097/PPO.0000000000000290. PMID: 29189329.
Article
Full Text Links
  • AHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr