title: In Patients with a Soft Pancreas, a Thick Parenchyma, a Small Duct, and Fatty Infiltration Are Significant Risks for Pancreatic Fistula After Pancreaticoduodenectomy.
abstract: This study sought to characterize soft and hard pancreatic textures radiologically and histologically, and to identify specific risks in a soft pancreas associated with postoperative pancreatic fistula (POPF) formation after pancreaticoduodenectomy (PD).
  
  
  
  Consecutive 145 patients who underwent PD at a single institution between January 2010 and May 2013 were studied. Pancreatic consistency was intraoperatively judged as soft or hard. Pancreatic configuration was assessed using preoperative CT. Histologic components of the pancreatic stump were evaluated using a morphometric analysis. Clinicopathologic parameters were then analyzed for the risk of clinically relevant POPF.
  
  
  
  Compared with patients with a hard pancreas (n = 66), those with a soft pancreas (n = 79) had a smaller main pancreatic duct (MPD) diameter and a larger parenchymal thickness on CT, had a smaller fibrosis ratio and a larger lobular ratio histologically, and developed clinically relevant POPF more frequently (P < 0.001 for all). In patients with a soft pancreas, an MPD diameter <2 mm, a parenchymal thickness ≥10 mm, a lobular ratio <75%, and a fat ratio ≥20% were independently associated with clinically relevant POPF (P < 0.010 for all).
  
  
  
  In patients with a soft pancreas, a thick parenchyma, a small MPD, and fatty infiltration were strongly associated with clinically relevant POPF after PD.
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan. msugimot@east.ncc.go.jp.|Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan. msugimot@east.ncc.go.jp.
authors.forename: Motokazu
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kojima
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D004067:Digestive System Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012307:Risk Factors
keywords: Fatty pancreas; Pancreatic lobules; Pancreaticoduodenectomy; Postoperative pancreatic fistula; Soft pancreas