title: Prediction of Pancreatic Fistula After Distal Pancreatectomy Based on Cross-Sectional Images.
abstract: Postoperative pancreatic fistula (POPF) is one of the most common and clinically relevant complications after distal pancreatectomy (DP), occurring in 5-40% of patients. Determining risk factors for this complication may aid in its prevention. This study sought to predict the development of POPF after DP preoperatively and objectively based on radiologic findings.
  
  
  
  This study included 60 patients who underwent DP using a stapler for pancreatic division between June 2011 and January 2013. Fatty infiltration, apparent diffusion coefficients (ADC) on preoperative MRI, pathologic fat, and fibrosis were measured. Pancreatic thickness and cross-sectional area of the pancreas stump on CT scan were also measured.
  
  
  
  Mean patient age was 60.5 years, 26 patients (46.3%) had pancreatic cancer and 20 (33.3%) underwent laparoscopic surgery. Clinically relevant POPF was observed in 12 patients (20.0%). Linear regression analysis showed a significant correlation between fat quantification on MRI and pathologic fat (pathologic fat = 1.978 × MR fat -6.393, p < 0.001, R2= 0.777). Univariate analysis showed that ≤8% fat on MRI (p = 0.040), ≤5% pathologic fat (p = 0.002), ADC ≤ 1.3 × 10-3mm2/s (p = 0.020), thicker pancreas (p = 0.007), and wider cross-sectional area of the pancreas (p = 0.013) were significantly associated with clinically relevant POPF after DP. Multivariate analysis revealed that pancreas thickness >17.6 mm [odds ratio (OR) 6.532, p = 0.064] and cross-sectional area >377 mm2(OR 12.676, p = 0.052) were marginally related to clinically relevant POPF.
  
  
  
  Pancreatic thickness and cross-sectional area of the transected surface of the pancreas are marginally significant risk factors for POPF development after DP. Measuring pancreatic thickness and cross-sectional area can be a promising tool for the preoperative prediction of POPF.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea.|Department of Surgery, Dankook University College of Medicine, Cheonan, Korea.
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Kang
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Jung
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.affiliation: Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyung Bun
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea. sunkim@snu.ac.kr.
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*