title: The Preoperative CT-Scan Can Help to Predict Postoperative Complications after Pancreatoduodenectomy.
abstract: After pancreatoduodenectomy, complication rates are up to 40%. To predict the risk of developing postoperative pancreatic fistula or severe complications, various factors were evaluated. 110 consecutive patients undergoing pancreatoduodenectomy at our institute between January 2012 and September 2014 with complete CT scan were retrospectively identified. Pre-, per-, and postoperative patients and pathological information were gathered. The CT-scans were analysed for the diameter of the pancreatic duct, attenuation of the pancreas, and the visceral fat area. All data was statistically analysed for predicting POPF and severe complications by univariate and multivariate logistic regression analyses. The POPF rate was 18%. The VFA measured at umbilicus (OR 1.01; 95% CI = 1.00-1.02; P = 0.011) was an independent predictor for POPF. The severe complications rate was 33%. Independent predictors were BMI (OR 1.24; 95% CI = 1.10-1.42; P = 0.001), ASA class III (OR 17.10; 95% CI = 1.60-182.88; P = 0.019), and mean HU (OR 0.98; 95% CI = 0.96-1.00; P = 0.024). In conclusion, VFA measured at the umbilicus seems to be the best predictor for POPF. BMI, ASA III, and the mean HU of the pancreatic body are independent predictors for severe complications following PD.
authors.affiliation: Department of Surgery, Medical Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands ; Faculty of Science and Technology, University of Twente, Netherlands.
authors.forename: Femke F
authors.initials: FF
authors.lastname: Schröder
authors.affiliation: Department of Surgery, Medical Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands ; Faculty of Science and Technology, University of Twente, Netherlands.
authors.forename: Feike
authors.initials: F
authors.lastname: de Graaff
authors.affiliation: Department of Radiology, Medical Spectrum Twente (MST), Enschede, Netherlands.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Bouman
authors.affiliation: Twente Medical School, Medical Spectrum Twente (MST), Enschede, Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
authors.affiliation: Faculty of Science and Technology, University of Twente, Netherlands.
authors.forename: Kees H
authors.initials: KH
authors.lastname: Slump
authors.affiliation: Department of Surgery, Medical Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands.
authors.forename: Joost M
authors.initials: JM
authors.lastname: Klaase
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed