Novel intraoperative use of the "Tensipresser" to assess factors predictive of pancreatic fistula after pancreaticoduodenectomy.
OBJECTIVE
Pancreatic fistula (PF) is a challenging complication of pancreaticoduodenectomy (PD). 'Soft pancreas' is reported as a risk factor for PF; however, palpation by the surgeon is not an objective method of evaluating pancreatic texture. We conducted this study to investigate whether a texture analyzer called a "Tensipresser" can be used to quantify pancreatic tissue hardness and predict the development of postoperative PF.


METHODS
We assessed pancreatic texture in 85 patients who underwent PD. After surgeons assessed the texture of the pancreas subjectively, the physical properties were measured on the pancreatic margin intraoperatively, by the two-bite method using the "Tensipresser". The incidence and severity of PF were based on the definitions of the International Study Group on Pancreatic Fistula.


RESULTS
Symptomatic PF (grade B and C) developed in 16% of the patients. Patients were divided into two groups based on the Tensipresser measurement: those with a soft and fragile pancreas with hardness < 2070 gw/cm2and cohesiveness < 0.65 (SF group); and all other patients (non-SF group). In the univariate and multivariate analysis, a small pancreatic duct diameter (<4 mm), no conduction of preoperative chemoradiation therapy, and inclusion in the SF group were significant predictors of PF.


CONCLUSIONS
The Tensipresser can evaluate pancreatic texture objectively, helping to define intraoperatively, those at risk of the development of PF.
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.|Department of Gastroenterological Surgery, Graduate School of Medicine Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
Manabu
http://orcid.org/0000-0002-6671-2698
M
Mikamori
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan. kgotou@gesurg.med.osaka-u.ac.jp.|Department of Gastroenterological Surgery, Graduate School of Medicine Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan. kgotou@gesurg.med.osaka-u.ac.jp.
Kunihito
K
Gotoh
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Hidenori
H
Takahashi
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Hirofumi
H
Akita
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Akira
A
Tomokuni
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Shogo
S
Kobayashi
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Masayuki
M
Ohue
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Yoshiyuki
Y
Fujiwara
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Masahiko
M
Yano
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Osamu
O
Ishikawa
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan.
Masato
M
Sakon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006244:Hardness; D006245:Hardness Tests / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000503:physiopathology*; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index
Pancreatic fistula; Pancreaticoduodenectomy; Soft pancreas