Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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The effect of atrophied pancreas as shown in the preoperative imaging on the leakage rate after pancreaticoduodenectomy

  • Ashraf Imam (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Harbi Khalayleh (Department of Surgery, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Meni Brakha (Department of Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University) ;
  • Ariel A. Benson (Department of Gastroenterology and Liver Diseases, Hadassah Medical Center) ;
  • Naama Lev-Cohain (Department of Radiology and Medical Imaging, Hadassah-Hebrew University Medical Center) ;
  • Gidon Zamir (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Abed Khalaileh (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem)
  • Received : 2021.10.19
  • Accepted : 2021.12.13
  • Published : 2022.05.31
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Abstract

Backgrounds/Aims: The soft texture of the pancreas parenchyma may influence the incidence of pancreatic leakage after pancreaticcoduodenectomy (PD). One possible method to assess pancreatic texture and atrophy, is via computed tomography (CT) scan of the abdomen. The purpose of our study was to evaluate the relation between the preoperative CT scan and the incidence of pancreatic fistula after PD. Methods: A retrospective single-center study including patients who underwent PD for a benign and malignant tumor of the periampullary region between the years 2000 and 2016. Demographic and imaging data were analysed and a correlation with the post-operative leak was evaluated. Results: Pancreatic leak was documented in 34 out of 154 (22.1%) patients. All the leakage cases occurred in the preserved pancreas group (33.1% of the total preserved pancreas group alone). No leak was documented in the atrophic pancreas group. This difference between the two groups was found to be statistically significant (p ≤ 0.00001). Conclusions: Atrophic pancreas in the preoperative CT scan may be protective against leakage after PD. These findings may help the surgeon to risk stratify patients accordingly. In addition, the findings suggest that patients with a preserved pancreas may require more protective methods to prevent leakage.

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References

  1. Pallisera A, Morales R, Ramia JM. Tricks and tips in pancreatoduodenectomy. World J Gastrointest Oncol 2014;6:344-350.
  2. Whipple AO. Pancreaticoduodenectomy for islet carcinoma: a fiveyear follow-up. Ann Surg 1945;121:847-852.
  3. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217:430-435; discussion 435-438.
  4. Trede M, Schwall G. The complications of pancreatectomy. Ann Surg 1988;207:39-47.
  5. Strasberg SM, Drebin JA, Soper NJ. Evolution and current status of the Whipple procedure: an update for gastroenterologists. Gastroenterology 1997;113:983-994.
  6. Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol 2005;11:2456-2461.
  7. Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 2007;246:1058-1064.
  8. Bartholomew LG, Baggenstoss AH, Morlock CG, Comfort MW. Primary atrophy and lipomatosis of the pancreas. Gastroenterology 1959;36:563-572.
  9. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8-13.
  10. Felix K, Schuck A, Gaida MM, Hinz U, Dovzhanskiy D, Werner J. Objective parameters aid the prediction of fistulas in pancreatic surgery. Exp Ther Med 2014;8:719-726.
  11. Kim Z, Kim MJ, Kim JH, Jin SY, Kim YB, Seo D, et al. Prediction of post-operative pancreatic fistula in pancreaticoduodenectomy patients using pre-operative MRI: a pilot study. HPB (Oxford) 2009;11:215-221.
  12. Frozanpor F, Loizou L, Ansorge C, Lundell L, Albiin N, Segersvard R. Correlation between preoperative imaging and intraoperative risk assessment in the prediction of postoperative pancreatic fistula following pancreatoduodenectomy. World J Surg 2014;38:2422-2429.
  13. Hong W, Ha HI, Lee JW, Lee SM, Kim MJ. Measurement of pancreatic fat fraction by CT histogram analysis to predict pancreatic fistula after pancreaticoduodenectomy. Korean J Radiol 2019;20:599-608.
  14. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252-1261.
  15. Hausmann S, Kong B, Michalski C, Erkan M, Friess H. The role of inflammation in pancreatic cancer. Adv Exp Med Biol 2014;816:129-151.
  16. Meckler KA, Brentnall TA, Haggitt RC, Crispin D, Byrd DR, Kimmey MB, et al. Familial fibrocystic pancreatic atrophy with endocrine cell hyperplasia and pancreatic carcinoma. Am J Surg Pathol 2001;25:1047-1053.
  17. Del Chiaro M, Segersvard R, Lohr M, Verbeke C. Early detection and prevention of pancreatic cancer: is it really possible today? World J Gastroenterol 2014;20:12118-12131.
  18. Hruban RH, Maitra A, Goggins M. Update on pancreatic intraepithelial neoplasia. Int J Clin Exp Pathol 2008;1:306-316.
  19. Chu LC, Goggins MG, Fishman EK. Diagnosis and detection of pancreatic cancer. Cancer J 2017;23:333-342.