中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 12
Dec.  2022
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(12): 2807-2813

Value of pancreatic anatomic structure under standard pancreatic neck transection in predicting pancreatic fistula after pancreaticoduodenectomy

DOI: 10.3969/j.issn.1001-5256.2022.12.022
  • 1.

    Department of Hepatobiliary Surgery, School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, China

  • 2.

    General Surgery Center, The General Hospital of Western Theater Command, Chengdu 610083, China

Research funding:

the Sichuan Science and Technology Program (2022YFS0195);

Project of Science and Technology Department of Sichuan Province (18SYXHZ0024);

Pancreatic injury and repair Key laboratory of Sichuan Province (41732152)

More Information
  • Corresponding author: DAI Ruiwu, dairuiwu@swjtu.edu.cn (ORCID: 0000-0002-5487-135X)
  • Received Date: 2022-07-08
  • Accepted Date: 2022-08-29
  • Published Date: 2022-12-20
    Abstract
  •   Objective  To investigate and validate the effect of relevant parameters of pancreatic anatomic structure under standard pancreatic neck transection in predicting postoperative pancreatic fistula (POPF).  Methods  A total of 140 patients who underwent pancreaticoduodenectomy (PD) in The General Hospital of Western Theater Command from June 2016 to December 2019 were enrolled as prediction group, and 82 patients who underwent PD in the same hospital from January 2020 to March 2021 were enrolled as validation group. Baseline levels were compared between the two groups. A univariate analysis was performed for the prediction group to screen out the risk factors for POPF, and in the validation group, the interclass correlation coefficient (ICC) was used to compare the consistency between preoperative imaging measurements and actual intraoperative measurements. The risk factors for POPF were validated in each group. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups; the chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression analysis was used to investigate the risk factors for POPF. Youden index was calculated, GraphPad Prism was used to plot the receiver operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was calculated. ICC was used for the reliability analysis of preoperative imaging measurements and actual intraoperative measurements.  Results  Pancreatic duct diameter at the pancreatic neck (odds ratio [OR]=0.347, 95% confidence interval [CI]: 0.192-0.626, P < 0.001), the major axis of the pancreatic neck parenchyma (OR=1.127, 95%CI: 1.031-1.231, P=0.008), and the minor axis of the pancreatic neck parenchyma (OR=1.350, 95% CI: 1.137-1.602, P=0.001) were risk factors for POPF. Pancreatic duct diameter at the pancreatic neck had an AUC of 0.785 (95%CI: 0.128-0.302, P < 0.001) and a cut-off value of 2.7 mm; the major axis of the pancreatic neck parenchyma had an AUC of 0.669 (95%CI: 0.564-0.774, P=0.006) and a cut-off value of 19.3 mm, and the minor axis of the pancreatic neck parenchyma had an AUC of 0.720 (95%CI: 0.627-0.813, P < 0.001) and a cut-off value of 9.9 mm. Preoperative imaging measurements were highly consistent with actual intraoperative measurements for 30 patients in the validation group, with an ICC of > 0.75 (P < 0.001). Grouping validation of cut-off values showed that there was a significant different in the incidence rate of POPF between the high-risk group and the low-risk group based on pancreatic duct diameter at the pancreatic neck (χ2=0.645, P=0.011), as well as between the high-risk group and the low-risk group based on the minor axis of the pancreatic neck parenchyma (χ2=5.901, P=0.015).  Conclusion  Structural features of the pancreatic neck under standard pancreatic neck transection are risk factors for POPF, which can be differentiated by preoperative CT, and the method is easy and convenient in clinical practice.

     

    • FullText(HTML)
  • loading
    • References(32)
  • [1]
    SHINDE RS, ACHARYA R, CHAUDHARI VA, et al. External validation and comparison of the original, alternative and updated-alternative fistula risk scores for the prediction of postoperative pancreatic fistula after pancreatoduodenectomy[J]. Pancreatology, 2020, 20(4): 751-756. DOI: 10.1016/j.pan.2020.04.006.
    [2]
    CASCIANI F, BASSI C, VOLLMER CM Jr. Decision points in pancreatoduodenectomy: Insights from the contemporary experts on prevention, mitigation, and management of postoperative pancreatic fistula[J]. Surgery, 2021, 170(3): 889-909. DOI: 10.1016/j.surg.2021.02.064.
    [3]
    DONG Q, LIU X, ZHANG RJ, et al. The influence of bundled ligation of the pancreatic stump on postoperative pancreatic fistula of distal pancreatectomy[J]. Chin J Dig Surg, 2021, 20(4): 419-424. DOI: 10.3760/cma.j.cn115610-20210203-00061.

    董勤, 刘旭, 张瑞坚, 等. 胰腺残端捆绑结扎对胰腺远端切除术后胰瘘的影响[J]. 中华消化外科杂志, 2021, 20(4): 419-424. DOI: 10.3760/cma.j.cn115610-20210203-00061.
    [4]
    GAO HQ, LI BY, MA YS, et al. Risk factors analysis and treatment of postpancreaticoduodenectomy hemorrhage[J]. Chin J Dig Surg, 2022, 21(4): 492-499. DOI: 10.3760/cma.j.cn115610-20220228-00111.

    高红桥, 李宝毅, 马永蔌, 等. 胰十二指肠切除术后出血的危险因素分析及治疗策略[J]. 中华消化外科杂志, 2022, 21(4): 492-499. DOI: 10.3760/cma.j.cn115610-20220228-00111.
    [5]
    PEDRAZZOLI S, BRAZZALE AR. Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management[J]. Langenbecks Arch Surg, 2020, 405(8): 1219-1231. DOI: 10.1007/s00423-020-02005-8.
    [6]
    LAO M, ZHANG X, GUO C, et al. External validation of alternative fistula risk score (a-FRS) for predicting pancreatic fistula after pancreatoduodenectomy[J]. HPB (Oxford), 2020, 22(1): 58-66. DOI: 10.1016/j.hpb.2019.05.007.
    [7]
    YU J, REN CY, WANG J, et al. Establishment of risk prediction model of postoperative pancreatic fistula after pancreatoduodenectomy: 2016 edition of definition and grading system of pancreatic fistula: a single center experience with 223 cases[J]. World J Surg Oncol, 2021, 19(1): 257. DOI: 10.1186/s12957-021-02372-6.
    [8]
    ZHANG B, YUAN Q, LI S, et al. Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2022, 101(26): e29757. DOI: 10.1097/MD.0000000000029757.
    [9]
    ROBERTS KJ, KARKHANIS S, PITCHAIMUTHU M, et al. Comparison of preoperative CT-based imaging parameters to predict postoperative pancreatic fistula[J]. Clin Radiol, 2016, 71(10): 986-992. DOI: 10.1016/j.crad.2016.06.108.
    [10]
    SUGIMOTO M, KENDRICK ML, FARNELL MB, et al. Relationship between pancreatic thickness and staple height is relevant to the occurrence of pancreatic fistula after distal pancreatectomy[J]. HPB (Oxford), 2020, 22(3): 398-404. DOI: 10.1016/j.hpb.2019.07.010.
    [11]
    WATANABE N, YAMAMOTO Y, SUGIURA T, et al. The impact of stump closure techniques on pancreatic fistula stratified by the thickness of the pancreas in distal pancreatectomy[J]. Dig Surg, 2020, 37(4): 340-347. DOI: 10.1159/000505061.
    [12]
    BOX EW, DENG L, MORGAN DE, et al. Preoperative anthropomorphic radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy[J]. Am J Surg, 2021, 222(1): 133-138. DOI: 10.1016/j.amjsurg.2020.10.023.
    [13]
    TAJIMA Y, KAWABATA Y, HIRAHARA N. Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy[J]. Surg Today, 2018, 48(2): 140-150. DOI: 10.1007/s00595-017-1529-3.
    [14]
    DATTA J, WILLOBEE BA, RYON EL, et al. Contemporary reappraisal of intraoperative neck margin assessment during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a review[J]. JAMA Surg, 2021, 156(5): 489-495. DOI: 10.1001/jamasurg.2020.5676.
    [15]
    BASSI C, MARCHEGIANI G, DERVENIS C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After[J]. Surgery, 2017, 161(3): 584-591. DOI: 10.1016/j.surg.2016.11.014.
    [16]
    HVTTNER FJ, FITZMAURICE C, SCHWARZER G, et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma[J]. Cochrane Database Syst Rev, 2016, 2: CD006053. DOI: 10.1002/14651858.CD006053.pub6.
    [17]
    SKANDALAKIS LJ, ROWE JS Jr, GRAY SW, et al. Surgical embryology and anatomy of the pancreas[J]. Surg Clin North Am, 1993, 73(4): 661-697. DOI: 10.1016/s0039-6109(16)46080-9.
    [18]
    BARDOL T, DELICQUE J, HERMIDA M, et al. Neck transection level and postoperative pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study of 195 patients[J]. Int J Surg, 2020, 82: 43-50. DOI: 10.1016/j.ijsu.2020.08.001.
    [19]
    RENBERG S, ZHANG Y, KARLSSON F, et al. The role of neoadjuvant imatinib in gastrointestinal stromal tumor patients: 20 years of experience from a tertial referral center[J]. Int J Cancer, 2022, 151(6): 906-913. DOI: 10.1002/ijc.34052.
    [20]
    YOU L, ZHAO W, HONG X, et al. The effect of body mass index on surgical outcomes in patients undergoing pancreatic resection: a systematic review and meta-analysis[J]. Pancreas, 2016, 45(6): 796-805. DOI: 10.1097/MPA.0000000000000525.
    [21]
    ZARZAVADJIAN LE BIAN A, FUKS D, MONTALI F, et al. Predicting the severity of pancreatic fistula after pancreaticoduodenectomy: overweight and blood loss as independent risk factors: retrospective analysis of 277 patients[J]. Surg Infect (Larchmt), 2019, 20(6): 486-491. DOI: 10.1089/sur.2019.027.
    [22]
    SHIMIZU A, TANI M, KAWAI M, et al. Influence of visceral obesity for postoperative pulmonary complications after pancreaticoduodenectomy[J]. J Gastrointest Surg, 2011, 15(8): 1401-1410. DOI: 10.1007/s11605-011-1436-7.
    [23]
    GRUPPO M, ANGRIMAN I, MARTELLA B, et al. Perioperative albumin ratio is associated with post-operative pancreatic fistula[J]. ANZ J Surg, 2018, 88(7-8): e602-e605. DOI: 10.1111/ans.14262.
    [24]
    SAKAMOTO T, YAGYU Y, UCHINAKA EI, et al. Predictive significance of c-reactive protein-to-albumin ratio for postoperative pancreatic fistula after pancreaticoduodenectomy[J]. Anticancer Res, 2019, 39(11): 6283-6290. DOI: 10.21873/anticanres.13838.
    [25]
    TEMPERO MA, MALAFA MP, CHIOREAN EG, et al. Pancreatic adenocarcinoma, version 1.2019[J]. J Natl Compr Canc Netw, 2019, 17(3): 202-210. DOI: 10.6004/jnccn.2019.0014.
    [26]
    NISHIDA Y, KATO Y, KUDO M, et al. Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy[J]. J Gastrointest Surg, 2016, 20(9): 1586-1594. DOI: 10.1007/s11605-016-3146-7.
    [27]
    MU W, LIU C, GAO F, et al. Prediction of clinically relevant Pancreatico-enteric Anastomotic Fistulas after Pancreatoduodenectomy using deep learning of Preoperative Computed Tomography[J]. Theranostics, 2020, 10(21): 9779-9788. DOI: 10.7150/thno.49671.
    [28]
    BARBIER L, MÈGE D, REYRE A, et al. Predict pancreatic fistula after pancreaticoduodenectomy: ratio body thickness/main duct[J]. ANZ J Surg, 2018, 88(5): E451-E455. DOI: 10.1111/ans.14048.
    [29]
    PARTELLI S, ANDREASI V, SCHIAVO LENA M, et al. The role of acinar content at pancreatic resection margin in the development of postoperative pancreatic fistula and acute pancreatitis after pancreaticoduodenectomy[J]. Surgery, 2021, 170(4): 1215-1222. DOI: 10.1016/j.surg.2021.03.047.
    [30]
    NAKAMURA H, MURAKAMI Y, UEMURA K, et al. Reduced pancreatic parenchymal thickness indicates exocrine pancreatic insufficiency after pancreatoduodenectomy[J]. J Surg Res, 2011, 171(2): 473-478. DOI: 10.1016/j.jss.2010.03.052.
    [31]
    STEGER U, RANGE P, MAYER F, et al. Pancreatic duct anatomy in the corpus area: implications for closure and anastomotic technique in pancreas surgery[J]. Langenbecks Arch Surg, 2010, 395(3): 201-206. DOI: 10.1007/s00423-009-0526-4.
    [32]
    UMEZAKI N, HASHIMOTO D, NAKAGAWA S, et al. Number of acinar cells at the pancreatic stump predicts pancreatic fistula after pancreaticoduodenectomy[J]. Surg Today, 2018, 48(8): 790-795. DOI: 10.1007/s00595-018-1656-5.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (1350) PDF downloads(50) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return