Preoperative computed tomography scan to predict pancreatic fistula after distal pancreatectomy using gland and tumor characteristics

Am J Surg. 2016 May;211(5):871-6. doi: 10.1016/j.amjsurg.2016.02.001. Epub 2016 Feb 23.


Background: Preoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed.

Methods: Risk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120).

Results: Forty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density (P = .0013), but density did not predict pancreatic fistula (P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis.

Conclusions: This multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.

Keywords: Distal pancreatectomy; Pancreatic fistula; Risk factors.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Biopsy, Needle
  • Cohort Studies
  • Female
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Pancreas / pathology*
  • Pancreas / surgery
  • Pancreatectomy / adverse effects*
  • Pancreatectomy / methods
  • Pancreatic Fistula / etiology*
  • Pancreatic Fistula / physiopathology
  • Pancreatic Fistula / surgery
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / surgery
  • Predictive Value of Tests
  • Preoperative Care / methods
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • Risk Adjustment
  • Survival Rate
  • Tomography, X-Ray Computed / methods*
  • Treatment Outcome