title: Significance of preoperative radiographic pancreatic density in predicting pancreatic fistula after surgery for pancreatic neuroendocrine tumors.
abstract: BACKGROUND
  Postoperative pancreatic fistula remains the most severe and worrisome complication after surgery. Predictive preoperative assessment remains challenging. The authors examine the role of pancreatic computed tomography density in predicting postoperative pancreatic fistula after surgery for pancreatic neuroendocrine tumors.
  
  
  METHODS
  A single institutional retrospective review of pancreatic surgery for neuroendocrine tumors between 1998 and 2010 was conducted. Preoperative contrast-enhanced computed tomography scans were reviewed, with mean region of interest measurements of pancreatic parenchymal density obtained from 10-mm thick axial computed tomography images.
  
  
  RESULTS
  A total of 119 patients were identified: 59 with enucleations and 60 with resections. Decreased preoperative pancreatic density was significantly associated with an increased grade of postoperative pancreatic fistula (P < .01). Subgroup analyses revealed that decreased gland density was associated with increased grade of postoperative pancreatic fistula in the resection (P < .01) but not in the enucleation group (P = .34).
  
  
  CONCLUSIONS
  A significant association between postoperative pancreatic fistula grade and preoperative pancreatic computed tomography density is observed in patients undergoing resection for pancreatic neuroendocrine tumors.
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Assadipour
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Saïd C
authors.initials: SC
authors.lastname: Azoury
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Schaub
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Young
authors.initials: Y
authors.lastname: Hong
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Robert
authors.initials: R
authors.lastname: Eil
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Inchauste
authors.affiliation: Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.affiliation: Radiology and Imaging Sciences NIH Clinical Center, National Institutes of Health, Bethesda, MD.
authors.forename: Aradhana M
authors.initials: AM
authors.lastname: Venkatesan
authors.affiliation: Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD. Electronic address: hughesm@mail.nih.gov.
authors.forename: Marybeth S
authors.initials: MS
authors.lastname: Hughes
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Neuroendocrine tumors; Pancreatic enucleation; Pancreatic fistula; Pancreatic resection; Pancreaticoduodenectomy