Pancreatic Fat and Body Composition Measurements by Computed Tomography are Associated with Pancreatic Fistula After Pancreatectomy

Tanaka, Kichinosuke; Yamada, Suguru; Sonohara, Fuminori; Takami, Hideki; Hayashi, Masamichi; Kanda, Mitsuro; Kobayashi, Daisuke; Tanaka, Chie; Nakayama, Goro; Koike, Masahiko; Fujiwara, Michitaka; Kodera, Yasuhiro

doi:10.1245/s10434-020-08581-9

Cited by 32 publications

(29 citation statements)

References 42 publications

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“…Also, different preoperative conditions (previous abdominal surgery, pancreatitis, stenting, etc.) may cause artefacts and interfere with the measurement of intraabdominal fat 6,26 . On the other hand, RRFT may potentially be more reliable, since it may be better standardized and is easier to calculate.…”

Section: Discussionmentioning

confidence: 99%

Retrorenal fat predicts grade C pancreatic fistula after pancreaticoduodenectomy

Kopljar

Čoklo

Krstačić

et al. 2020

ANZ Journal of Surgery

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Background: Pancreatic fistula after pancreaticoduodenectomy is one of the most severe complications with mortality rates as high as 45%, and the prediction of most severe form of fistula (grade C) is crucial for successful management of patients who are to undergo cephalic pancreatoduodenectomy. It has been found that the amount of abdominal fat may predict grade C postoperative pancreatic fistula. In this study, we analysed the value of retrorenal fat thickness in the prediction of grade C pancreatic fistula. Methods: A total of 140 patients who underwent pancreaticoduodenectomy were retrospectively analysed. Retrorenal fat thickness and intra-abdominal fat, expressed as total fat area, visceral fat area and subcutaneous fat area, were determined from computed tomography slices using the known range of attenuation values (−190 to −30). Blood loss, operating time, pancreatic texture and main pancreatic duct diameter as well as body mass index were also analysed. Results: Retrorenal fat thickness (P = 0.0004), duct diameter (P = 0.0008), subcutaneous fat area (P = 0.023) and total fat area (P = 0.014) were found to be significant predictors of grade C pancreatic fistula. Conclusion: Although retrorenal fat tissue thickness may seem robust, it is a simple measure that can be used to predict the most severe grade of pancreatic fistula after pancreaticoduodenectomy.

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Section: Discussionmentioning

confidence: 99%

Retrorenal fat predicts grade C pancreatic fistula after pancreaticoduodenectomy

Kopljar

Čoklo

Krstačić

et al. 2020

ANZ Journal of Surgery

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“…Publication bias was assessed by Egger's and Begg's tests. In articles reporting the prevalence of POPF (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), the P-values of each test were 0.436 and 0.324, respectively, indicating no evidence of publication bias in the included studies. Similarly, no bias was found in the study reporting the incidence of FP in people with POPF disease (11-15, 17, 20, 21), with the P-values of each test being 0.386 and 0.409, respectively.…”

Section: Publication Biasmentioning

confidence: 97%

“…Five of the included studies focused on Asian patients, while the rest focused mainly on patients from Europe or North America. Eleven studies (including 2484) used the pathological method to determine FP (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). There were eight articles in which the number of individuals with FP was extractable (11-15, 17, 20, 21), and 5 (11,14,15,17,21) had the same diagnostic criteria for FP.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eleven studies (including 2484) used the pathological method to determine FP (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). There were eight articles in which the number of individuals with FP was extractable (11-15, 17, 20, 21), and 5 (11,14,15,17,21) had the same diagnostic criteria for FP. The criteria were as follows: the total score of pancreatic fatty infiltration was obtained by the addition of both perilobular and intralobular scores.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…After screening all the studies, a total of 11 studies (including 2484 individuals) explored POPF in patients who underwent pancreaticoduodenectomy (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Therefore, the included studies could be applied to investigate prevalence in the metaanalysis.…”

Section: Prevalence Of Popfmentioning

confidence: 99%

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Impact of Fatty Pancreas on Postoperative Pancreatic Fistulae: A Meta-Analysis

et al. 2021

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BackgroundSoft pancreas is widely recognized as an important risk factor for the development of postoperative pancreatic fistula (POPF). Although fatty pancreas (FP) has not been formally defined as a cause of pancreatic fistula, existing research has shown that it can increase the incidence of POPF by increasing pancreatic tenderness; therefore, it may be a potential risk factor. This study aimed to discern whether FP was associated with POPF.MethodTwo reviewers independently performed literature searches from five electronic databases. According to the established inclusion criteria, we extracted necessary data from the studies that met the criteria for further analysis. We pooled the odds ratios (ORs) from individual studies using a random-effects model to investigate the associations between POPF and the prognosis of FP.ResultA total of 11 studies involving 2484 individuals were included. The pooled prevalence of POPF was 18% (95% CI: 12-24%). Body mass index (BMI) was associated with a significantly increased risk of POPF (OR=3.55; 95% CI: 1.83, 6.86; P=0.0002; I²=0). FP was obviously associated with the occurrence of POPF (OR=3.75; 95% CI: 1.64, 8.58; P=0.002; I²=78).ConclusionFP is closely associated with the development of POPF, and the early identification of these high-risk patients can help to reduce the incidence of POPF.Systematic Review RegistrationThe Registration URL link is (https://www.crd.york.ac.uk/PROSPERO/). The ID is “CRD42021265141”.

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A new fistula risk score using sarcopenic obesity and subcutaneous fat area for predicting postoperative pancreatic fistula after pancreaticoduodenectomy

Hayashi

Shimizu

Koyama

et al. 2022

J Hepato Biliary Pancreat

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Background/Purpose: Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy and current predictors of POPF are inadequate. We developed a new fistula score to more accurately predict POPF. Methods: We retrospectively reviewed 169 patients who underwent pancreaticoduodenectomy between January 2010 and August 2021 at our institution and examined patients' risk factors according to the occurrence of grade B/C POPF. Muscle and fat were assessed on preoperative computed tomography images and cutoff values were determined by receiver operating characteristic curve analysis.Results: Grade B/C POPF occurred in 38 (22.5%) patients. Multivariate analysis of patients' risk factors revealed that sarcopenic obesity (odds ratio [OR] 2.94; p = .033), L3 subcutaneous fat area (SFA) ≥ 98.0 cm 2 (OR 2.69; p = .049), and soft pancreatic texture (OR 27.5; p = .002) were independent risk factors of grade B/C POPF occurrence. In addition, a new fistula risk score based on these factors revealed that 63.6% of patients with high scores developed grade B/C POPF, while those with negligible or low scores did not. Conclusions:A new fistula risk scoring system based on sarcopenic obesity, SFA, and pancreatic texture may accurately predict POFP.

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Pancreatic Fat and Body Composition Measurements by Computed Tomography are Associated with Pancreatic Fistula After Pancreatectomy

Cited by 32 publications

References 42 publications

Retrorenal fat predicts grade C pancreatic fistula after pancreaticoduodenectomy

Retrorenal fat predicts grade C pancreatic fistula after pancreaticoduodenectomy

Impact of Fatty Pancreas on Postoperative Pancreatic Fistulae: A Meta-Analysis

A new fistula risk score using sarcopenic obesity and subcutaneous fat area for predicting postoperative pancreatic fistula after pancreaticoduodenectomy

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