Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy
<i>Background and Objectives</i>: 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 parameter...
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MDPI AG
2021-06-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/7/650 |
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| author | Marius Lucian Savin Florin Mihai Liliana Gheorghe Corina Lupascu Ursulescu Dragos Negru Ana Maria Trofin Mihai Zabara Vlad Nutu Ramona Cadar Mihaela Blaj Oana Lovin Felicia Crumpei Cristian Lupascu |
| author_facet | Marius Lucian Savin Florin Mihai Liliana Gheorghe Corina Lupascu Ursulescu Dragos Negru Ana Maria Trofin Mihai Zabara Vlad Nutu Ramona Cadar Mihaela Blaj Oana Lovin Felicia Crumpei Cristian Lupascu |
| author_sort | Marius Lucian Savin |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: 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. <i>Materials and Methods</i>: 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. <i>Results</i>: 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, <i>p</i> = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, <i>p</i> = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, <i>p</i> = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, <i>p</i> = 0.02) and ERPV (46.37 ± 10.39 cm<sup>3</sup> vs. 34.87 ± 12.35 cm<sup>3</sup>, <i>p</i> = 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. <i>Conclusions</i>: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula. |
| first_indexed | 2024-03-10T10:05:22Z |
| format | Article |
| id | doaj.art-377e5227f0f24267808dd6ff0f4511ad |
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| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T10:05:22Z |
| publishDate | 2021-06-01 |
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| series | Medicina |
| spelling | doaj.art-377e5227f0f24267808dd6ff0f4511ad2023-11-22T01:33:09ZengMDPI AGMedicina1010-660X1648-91442021-06-0157765010.3390/medicina57070650Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic PancreatoduodenectomyMarius Lucian Savin0Florin Mihai1Liliana Gheorghe2Corina Lupascu Ursulescu3Dragos Negru4Ana Maria Trofin5Mihai Zabara6Vlad Nutu7Ramona Cadar8Mihaela Blaj9Oana Lovin10Felicia Crumpei11Cristian Lupascu12“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Surgery, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Anesthesiology and Intensive Care, “St. Spiridon” Emergency Hospital, 700111 Iasi, RomaniaDepartment of Surgery, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania“Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania<i>Background and Objectives</i>: 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. <i>Materials and Methods</i>: 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. <i>Results</i>: 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, <i>p</i> = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, <i>p</i> = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, <i>p</i> = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, <i>p</i> = 0.02) and ERPV (46.37 ± 10.39 cm<sup>3</sup> vs. 34.87 ± 12.35 cm<sup>3</sup>, <i>p</i> = 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. <i>Conclusions</i>: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.https://www.mdpi.com/1648-9144/57/7/650clinically relevant pancreatic fistulapancreatic volumetrycomputer tomographypancreatoduodenectomy |
| spellingShingle | Marius Lucian Savin Florin Mihai Liliana Gheorghe Corina Lupascu Ursulescu Dragos Negru Ana Maria Trofin Mihai Zabara Vlad Nutu Ramona Cadar Mihaela Blaj Oana Lovin Felicia Crumpei Cristian Lupascu Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy Medicina clinically relevant pancreatic fistula pancreatic volumetry computer tomography pancreatoduodenectomy |
| title | Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy |
| title_full | Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy |
| title_fullStr | Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy |
| title_full_unstemmed | Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy |
| title_short | Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy |
| title_sort | proposal of a preoperative ct based score to predict the risk of clinically relevant pancreatic fistula after cephalic pancreatoduodenectomy |
| topic | clinically relevant pancreatic fistula pancreatic volumetry computer tomography pancreatoduodenectomy |
| url | https://www.mdpi.com/1648-9144/57/7/650 |
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