Significance of preoperative radiographic pancreatic density in predicting pancreatic fistula after surgery for pancreatic neuroendocrine tumors

Am J Surg. 2016 Jul;212(1):40-6. doi: 10.1016/j.amjsurg.2015.07.031. Epub 2015 Dec 12.


Background: Postoperative pancreatic fistula remains the most severe and worrisome complication after surgery. Predictive preoperative assessment remains challenging. The authors examine the role of pancreatic computed tomography density in predicting postoperative pancreatic fistula after surgery for pancreatic neuroendocrine tumors.

Methods: A single institutional retrospective review of pancreatic surgery for neuroendocrine tumors between 1998 and 2010 was conducted. Preoperative contrast-enhanced computed tomography scans were reviewed, with mean region of interest measurements of pancreatic parenchymal density obtained from 10-mm thick axial computed tomography images.

Results: A total of 119 patients were identified: 59 with enucleations and 60 with resections. Decreased preoperative pancreatic density was significantly associated with an increased grade of postoperative pancreatic fistula (P < .01). Subgroup analyses revealed that decreased gland density was associated with increased grade of postoperative pancreatic fistula in the resection (P < .01) but not in the enucleation group (P = .34).

Conclusions: A significant association between postoperative pancreatic fistula grade and preoperative pancreatic computed tomography density is observed in patients undergoing resection for pancreatic neuroendocrine tumors.

Keywords: Neuroendocrine tumors; Pancreatic enucleation; Pancreatic fistula; Pancreatic resection; Pancreaticoduodenectomy.

MeSH terms

  • Adult
  • Female
  • Humans
  • Incidence
  • Intraoperative Care
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / diagnosis
  • Neuroendocrine Tumors / mortality
  • Neuroendocrine Tumors / surgery*
  • Pancreas / pathology
  • Pancreatectomy / adverse effects
  • Pancreatectomy / methods
  • Pancreatic Fistula / epidemiology
  • Pancreatic Fistula / etiology*
  • Pancreatic Fistula / physiopathology
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticoduodenectomy / methods
  • Postoperative Complications / epidemiology
  • Postoperative Complications / pathology
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Survival Rate
  • Tomography, X-Ray Computed / methods*
  • Treatment Outcome