title: Preoperative Computed Tomography to Predict and Stratify the Risk of Severe Pancreatic Fistula After Pancreatoduodenectomy.
abstract: The aim of this article is to assess whether measures of abdominal fat distribution, visceral density, and antropometric parameters obtained from computed tomography (CT) may predict postoperative pancreatic fistula (POPF) occurrence.We analyzed 117 patients who underwent pancreatoduodenectomy (PD) and had a preoperative CT scan as staging in our center. CT images were processed to obtain measures of total fat volume (TFV), visceral fat volume (VFV), density of spleen, and pancreas, and diameter of pancreatic duct. The predictive ability of each parameter was investigated by receiver-operating characteristic (ROC) curves methodology and assessing optimal cutoff thresholds. A stepwise selection method was used to determine the best predictive model.Clinically relevant (grades B and C) POPF occurred in 24 patients (20.5%). Areas under ROC-curves showed that none of the parameters was per se significantly predictive. The multivariate analysis revealed that a VFV >2334 cm, TFV >4408 cm, pancreas/spleen density ratio <0.707, and pancreatic duct diameter <5 mm were predictive of POPF. The risk of POPF progressively increased with the number of factors involved and age.It is possible to deduce objective information on the risk of POPF from a simple and routine preoperative radiologic workup.
authors.affiliation: From the Department of Surgery and Translational Medicine (MS, LN, MB, SB, LG), Milano-Bicocca University, San Gerardo Hospital; Department of Health Sciences (DPB), Center of Biostatistics for Clinical Epidemiology, Milano-Bicocca University; Department of Radiology (DI, DF), San Gerardo Hospital, Monza, Italy; and International Research Center in Hepato-Biliary-Pancreatic Diseases, Monza, Italy (LG).
authors.forename: Marta
authors.initials: M
authors.lastname: Sandini
authors.forename: Davide Paolo
authors.initials: DP
authors.lastname: Bernasconi
authors.forename: Davide
authors.initials: D
authors.lastname: Ippolito
authors.forename: Luca
authors.initials: L
authors.lastname: Nespoli
authors.forename: Melissa
authors.initials: M
authors.lastname: Baini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Barbaro
authors.forename: Davide
authors.initials: D
authors.lastname: Fior
authors.forename: Luca
authors.initials: L
authors.lastname: Gianotti
mesh_terms: D000328:Adult; D000368:Aged; D050218:Body Fat Distribution; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000000981:diagnostic imaging; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000175:diagnosis; D011300:Preoperative Care / Q000379:methods*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed