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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 12
Dec.  2022
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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.

     

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