Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Miyamoto, Ryoichi; Oshiro, Yukio; Sano, Nobuyuki; Inagawa, Satoshi; Ohkohchi, Nobuhiro

doi:10.1159/000495406

Cited by 9 publications

(3 citation statements)

References 29 publications

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“…Some 23 665 patients had malignant disease and of these 12 097 had pancreatic ductal adenocarcinoma, 3778 distal cholangiocarcinoma, 3189 ampullary carcinoma and 1456 duodenal carcinoma. Study characteristics are summarized in Table S3 14–126 . Ninety‐one studies were retrospective cohort studies, 28 prospective cohort studies and three randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Kamarajah

Bundred

Lin

et al. 2020

ANZ Journal of Surgery

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Background Many studies have explored factors relating to post‐operative pancreatic fistula (POPF); however, the original definition (All‐POPF) was revised to include only ‘clinically relevant’ (CR) POPF. This study identified variables associated with the two International Study Group on Pancreatic Surgery definitions to identify which variables are more strongly associated with CR‐POPF. Methods A systematic review identified all studies reporting risk factors for POPF (using both International Study Group on Pancreatic Fistula definitions) following pancreatoduodenectomy. The primary outcome was factors associated with CR‐POPF. Meta‐analyses (random effects models) of pre‐, intra‐ and post‐operative factors associated with POPF in more than two studies were included. Results Among 52 774 patients All‐POPF (n = 69 studies) and CR‐POPF (n = 53 studies) affected 27% (95% confidence interval (CI95%) 23–30) and 19% (CI95% 17–22), respectively. Of the 176 factors, 24 and 17 were associated with All‐ and CR‐POPF, respectively. Absence of pre‐operative pancreatitis, presence of renal disease, no pre‐operative neoadjuvant therapy, use of post‐operative somatostatin analogues, absence of associated venous or arterial resection were associated with CR‐POPF but not All‐POPF. Conclusion In conclusion this study demonstrates wide variation in reported rates of POPF and that several risk factors associated with CR‐POPF are not used within risk prediction models. Data from this study can be used to shape future studies, research and audit across ethnic and geographic boundaries in POPF following pancreatoduodenectomy.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Kamarajah

Bundred

Lin

et al. 2020

ANZ Journal of Surgery

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“…In our dataset, the threshold value for the pancreatic duct size was found similar to the one found by Xia et al [ 19 ]. Additionally, our study obtained a different cutoff value for the estimated remnant pancreatic volume as compared to Miyamoto et al [ 30 ].…”

Section: Discussionmentioning

confidence: 60%

Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy

et al. 2021

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Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 ± 6.8 HU vs. 50.4 ± 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, p = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, p = 0.02) and ERPV (46.37 ± 10.39 cm3 vs. 34.87 ± 12.35 cm3, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694–0.941) and 0.774 (95% CI 0.599–0.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.

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“…We first measured the TPV (cm 3 ) using SYNAPSE VINCENT image analysis system (Fujifilm Inc.) according to the methods previously reported 21 . In brief, to avoid the influence of partial volume effect, the manually outlined pancreas on axial image slices were summed automatically throughout the entire pancreas.…”

Section: Assessment Of Pancreatic Volume By Mdctmentioning

confidence: 99%

Pancreatic fat accumulation evaluated by multidetector computed tomography in patients with type 2 diabetes

Fukase

Fukui

Sasamori

et al. 2020

J of Diabetes Invest

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Aims To clarify the clinical impact of pancreatic fat volume on beta cell function in type 2 diabetes patients. Materials and Methods One hundred thirty two consecutive type 2 diabetic patients (mean age, 63.7 years) were enrolled in this cross‐sectional study. Total pancreatic volume (TPV), pancreatic fat volume (PFV), and pancreatic parenchymal volume (PPV), and visceral fat volume were examined quantitatively with multidetector computed tomography using SYNAPSE VINCENT image analysis system (Fujifilm Inc., Tokyo, Japan). Pancreatic fat was identified using Hounsfield Units of less than zero. The capacity of insulin secretion was assessed by C‐peptide immunoreactivity (CPR) index (100 × fasting CPR/fasting plasma glucose). Insulin sensitivity was evaluated using CPR‐insulin resistance (20/fasting CPR × fasting plasma glucose). Results TPV, PFV, PPV, and visceral fat volume were significantly correlated with body weight (BW). PPV/BW, but not PFV/BW, significantly decreased with increasing duration of diabetes and aging. PFV/BW was positively associated with body mass index and visceral fat volume/BW. PFV/BW was significantly correlated with CPR index, while inversely associated with insulin sensitivity. CPR index, but not CPRinsulin resistance was progressively decreased in patients with a longer duration of diabetes. When patients were divided into two groups according to a median PFV/BW value, CPR index in high PFV/BW group with diabetes duration >5 years was significantly lower than those ≤5 years. However, duration‐dependent decrease in CPR index was not observed in low PFV/BW group. Conclusions Our present study suggests that PFV might predict the progression of beta cell dysfunction in patients with type 2 diabetes.

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Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Cited by 9 publications

References 29 publications

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy

Pancreatic fat accumulation evaluated by multidetector computed tomography in patients with type 2 diabetes

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