title: Quantification of pancreatic stiffness on intraoperative ultrasound elastography and evaluation of its relationship with postoperative pancreatic fistula.
abstract: "Soft pancreas" has often been reported as a predictive factor for postoperative pancreatic fistula (POPF) after pancreatectomy. However, pancreatic stiffness is judged subjectively by surgeons, without objective criteria. In the present study, pancreatic stiffness was quantified using intraoperative ultrasound elastography, and its relevance to POPF and histopathology was investigated. Forty-one patients (pancreatoduodenectomy, 30; distal pancreatectomy, 11) who underwent intraoperative elastography during pancreatectomy were included. The elastic ratio was determined at the pancreatic resection site (just above the portal vein) and at the remnant pancreas (head or tail). Correlations between the incidence of POPF and patient characteristics, operative variables, and the elastic ratio were examined. In addition, the relationship between the elastic ratio and the percentage of the exocrine gland at the resection stump was investigated. For pancreatoduodenectomy patients, main pancreatic duct diameter < 3.2 mm and elastic ratio < 2.09 were significant risk factors for POPF. In addition, the elastic ratio, but not main pancreatic duct diameter, was significantly associated with the percentage of exocrine gland area at the pancreatic resection stump. Pancreatic stiffness can be quantified using intraoperative elastography. Elastography can be used to diagnose "soft pancreas" and may thus be useful in predicting the occurrence of POPF.
authors.affiliation: 1 Department of Hepato-Biliary-Pancreatic Surgery and Breast Surgery, Graduate School of Medicine, Ehime University, Ehime, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Hatano
authors.forename: Jota
authors.initials: J
authors.lastname: Watanabe
authors.forename: Fumiki
authors.initials: F
authors.lastname: Kushihata
authors.forename: Taiji
authors.initials: T
authors.lastname: Tohyama
authors.forename: Taira
authors.initials: T
authors.lastname: Kuroda
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Koizumi
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Hisano
authors.forename: Atsuro
authors.initials: A
authors.lastname: Sugita
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors
keywords: Elastography; Exocrine gland; Pancreatectomy; Pancreatic stiffness; Postoperative pancreatic fistula