Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patients
BackgroundPostoperative pancreatic fistula (POPF) is the most critical complication after pancreatoduodenectomy (PD). Preoperative identification of high-risk patients and optimal pancreatic reconstruction technique can be a way to reduce postoperative complications.MethodsA series of 386 patients u...
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1039191/full |
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| author | Colin M. Krueger Colin M. Krueger Melanie Langheinrich Esther A. Biesel Lena Kundel Karsten Krueger Ulrich Adam Hartwig Riediger |
| author_facet | Colin M. Krueger Colin M. Krueger Melanie Langheinrich Esther A. Biesel Lena Kundel Karsten Krueger Ulrich Adam Hartwig Riediger |
| author_sort | Colin M. Krueger |
| collection | DOAJ |
| description | BackgroundPostoperative pancreatic fistula (POPF) is the most critical complication after pancreatoduodenectomy (PD). Preoperative identification of high-risk patients and optimal pancreatic reconstruction technique can be a way to reduce postoperative complications.MethodsA series of 386 patients underwent PD over a 10-year period (2009–2019). On routinely performed preoperative computed tomography (CT) images, the ventro-dorsal diameters of duct (D) and parenchyma (P) were measured in the cutting plane at the superior mesenteric vein. Then, the ratio of both values was calculated (D/P ratio) Double-layer pancreatojejunostomy with alignment of duct and mucosa (ADAM) by two monofilament threads (MFT) was performed in 359 patients and pancreatogastrostomy (PG) in 27 patients. The incidence of POPF was diagnosed according to the International Study Group for Pancreatic Fistula criteria.ResultsThe overall rate of POPF was 21% (n = 80), and the rate of clinically relevant type B/C fistulas 6.5% (n = 25). A D/P ratio of <0.2 was significantly associated with type B/C fistula (11%, p < 0.01). In low-risk patients (D/P ratio >0.2), type B/C fistula occurred only in 2%, and in high-risk patients (D/P ratio <0.2) in 9%. ADAM anastomosis was performed safely by two different surgeons. A PG anastomosis had double-digit POPF rates in all groups.ConclusionPreoperative CT imaging with D/P measurement may predict the risk of POPF development. A cut off D/P ratio of <0.2 was significantly associated with clinical relevant POPF. ADAM anastomosis may be an option for pancreatojejunostomy. However, preoperative knowledge of the D/P ratio could guide decision-making for primary pancreatectomy when pancreatic reconstruction is critical. |
| first_indexed | 2024-04-12T10:39:04Z |
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| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-12T10:39:04Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj.art-424677fbeb62424f9b276ba4ec3c70562022-12-22T03:36:39ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-11-01910.3389/fsurg.2022.10391911039191Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patientsColin M. Krueger0Colin M. Krueger1Melanie Langheinrich2Esther A. Biesel3Lena Kundel4Karsten Krueger5Ulrich Adam6Hartwig Riediger7Department of Surgery, Immanuel Clinic Ruedersdorf, University Clinic of Brandenburg Medical School, Berlin, GermanyDepartment of Surgery, Clinic of General-, Visceral-, Vascular and Thoracic Surgery, University Medicine Greifswald, Greifswald, GermanyDepartment of Surgery, Clinic of General-, Visceral-, Vascular and Thoracic Surgery, University Medicine Greifswald, Greifswald, GermanyDepartment of General and Visceral Surgery, Faculty of Medicine, Medical Center—University of Freiburg, Freiburg im Breisgau, GermanyDepartment of General Surgery, Vivantes-Humboldt Hospital, Berlin, GermanyInstitute of Diagnostic and Interventional Radiology, Vivantes-Humboldt Hospital, Berlin, GermanyDepartment of General Surgery, Vivantes-Humboldt Hospital, Berlin, GermanyDepartment of General Surgery, Vivantes-Humboldt Hospital, Berlin, GermanyBackgroundPostoperative pancreatic fistula (POPF) is the most critical complication after pancreatoduodenectomy (PD). Preoperative identification of high-risk patients and optimal pancreatic reconstruction technique can be a way to reduce postoperative complications.MethodsA series of 386 patients underwent PD over a 10-year period (2009–2019). On routinely performed preoperative computed tomography (CT) images, the ventro-dorsal diameters of duct (D) and parenchyma (P) were measured in the cutting plane at the superior mesenteric vein. Then, the ratio of both values was calculated (D/P ratio) Double-layer pancreatojejunostomy with alignment of duct and mucosa (ADAM) by two monofilament threads (MFT) was performed in 359 patients and pancreatogastrostomy (PG) in 27 patients. The incidence of POPF was diagnosed according to the International Study Group for Pancreatic Fistula criteria.ResultsThe overall rate of POPF was 21% (n = 80), and the rate of clinically relevant type B/C fistulas 6.5% (n = 25). A D/P ratio of <0.2 was significantly associated with type B/C fistula (11%, p < 0.01). In low-risk patients (D/P ratio >0.2), type B/C fistula occurred only in 2%, and in high-risk patients (D/P ratio <0.2) in 9%. ADAM anastomosis was performed safely by two different surgeons. A PG anastomosis had double-digit POPF rates in all groups.ConclusionPreoperative CT imaging with D/P measurement may predict the risk of POPF development. A cut off D/P ratio of <0.2 was significantly associated with clinical relevant POPF. ADAM anastomosis may be an option for pancreatojejunostomy. However, preoperative knowledge of the D/P ratio could guide decision-making for primary pancreatectomy when pancreatic reconstruction is critical.https://www.frontiersin.org/articles/10.3389/fsurg.2022.1039191/fullpancreatic surgerypostoperative pancreatic fistulaalignment of duct-and-mucosapancreatojejunostomypreoperative risk assessment |
| spellingShingle | Colin M. Krueger Colin M. Krueger Melanie Langheinrich Esther A. Biesel Lena Kundel Karsten Krueger Ulrich Adam Hartwig Riediger Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patients Frontiers in Surgery pancreatic surgery postoperative pancreatic fistula alignment of duct-and-mucosa pancreatojejunostomy preoperative risk assessment |
| title | Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patients |
| title_full | Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patients |
| title_fullStr | Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patients |
| title_full_unstemmed | Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patients |
| title_short | Preoperative risk assessment for postoperative pancreatic fistula (POPF): Image-based calculation of duct-to-parenchyma (D/P) ratio and an Alignment of Duct and Mucosa (ADAM) anastomosis may lead to a low POPF rate—results from 386 patients |
| title_sort | preoperative risk assessment for postoperative pancreatic fistula popf image based calculation of duct to parenchyma d p ratio and an alignment of duct and mucosa adam anastomosis may lead to a low popf rate results from 386 patients |
| topic | pancreatic surgery postoperative pancreatic fistula alignment of duct-and-mucosa pancreatojejunostomy preoperative risk assessment |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1039191/full |
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