title: Preoperative computed tomography scan to predict pancreatic fistula after distal pancreatectomy using gland and tumor characteristics.
abstract: BACKGROUND
  Preoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed.
  
  
  METHODS
  Risk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120).
  
  
  RESULTS
  Forty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density (P = .0013), but density did not predict pancreatic fistula (P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis.
  
  
  CONCLUSIONS
  This multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Jutric
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
authors.forename: W Cory
authors.initials: WC
authors.lastname: Johnston
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Grendar
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Haykin
authors.affiliation: Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
authors.forename: Connor
authors.initials: C
authors.lastname: Mathews
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Liv K
authors.initials: LK
authors.lastname: Harmon
authors.affiliation: Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
authors.forename: Jian
authors.initials: J
authors.lastname: Shen
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Hejin P
authors.initials: HP
authors.lastname: Hahn
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Coy
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Helton
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Flavio G
authors.initials: FG
authors.lastname: Rocha
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Wolf
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA.
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Alseidi
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA. Electronic address: philippa.newell@gmail.com.
authors.forename: Pippa H
authors.initials: PH
authors.lastname: Newell
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D020379:Risk Adjustment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Distal pancreatectomy; Pancreatic fistula; Risk factors