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Prediction of pancreatic fistula after pancreatoduodenectomy by preoperative dynamic CT and fecal elastase-1 levels

 Jung-Hyun Kang  ;  Joon Seong Park  ;  Jeong-Sik Yu  ;  Jae-Joon Chung  ;  Joo Hee Kim  ;  Eun-Suk Cho  ;  Dong Sup Yoon 
 PLOS ONE, Vol.12(5) : e0177052, 2017 
Journal Title
Issue Date
Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Pancreas/diagnostic imaging ; Pancreas/surgery* ; Pancreatic Ducts ; Pancreatic Elastase/analysis* ; Pancreatic Fistula/diagnosis* ; Pancreatic Fistula/diagnostic imaging ; Pancreatic Fistula/surgery* ; Pancreaticoduodenectomy ; Preoperative Period ; ROC Curve ; Retrospective Studies ; Tomography, X-Ray Computed
OBJECTIVE: To validate preoperative dynamic CT and fecal elastase-1 level in predicting the development of pancreatic fistulae after pancreatoduodenectomy.

MATERIALS AND METHODS: For 146 consecutive patients, CT attenuation values of the nontumorous pancreatic parenchyma were retrospectively measured on precontrast, arterial and equilibrium phase images for calculation of enhancement ratios. CT enhancement ratios and preoperative fecal elastase-1 levels were correlated with the development of pancreatic fistulae using independent t-test, logistic regression models, ROC analysis, Youden method and tree analysis.

RESULTS: The mean value of enhancement ratio on equilibrium phase was significantly higher (p = 0.001) in the patients without pancreatic fistula (n = 107; 2.26±3.63) than in the patients with pancreatic fistula (n = 39; 1.04±0.51); in the logistic regression analyses, it was significant predictor for the development of pancreatic fistulae (odds ratio = 0.243, p = 0.002). The mean preoperative fecal elastase-1 levels were higher (odds ratio = 1.003, p = 0.034) in the pancreatic fistula patients than other patients, but there were no significant differences in the areas under the curve between the prediction values of CT enhancement ratios and fecal elastase-1 combined and those of CT enhancement ratios alone (P = 0.897, p = 0.917) on ROC curve analysis. Tree analysis revealed that the CT enhancement ratio was more powerful predictor of pancreatic fistula than fecal elastase-1 levels.

CONCLUSION: The preoperative CT enhancement ratio of pancreas acquired at equilibrium phase regardless of combination with fecal elastase-1 levels might be a useful predictor of the risk of developing a pancreatic fistula following pancreatoduodenectomy.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Jung Hyun(강졍현)
Kim, Joo Hee(김주희) ORCID logo https://orcid.org/0000-0001-5383-3602
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
Yu, Jeong Sik(유정식) ORCID logo https://orcid.org/0000-0002-8171-5838
Yoon, Dong Sup(윤동섭) ORCID logo https://orcid.org/0000-0001-6444-9606
Chung, Jae Joon(정재준) ORCID logo https://orcid.org/0000-0002-7447-1193
Cho, Eun Suk(조은석)
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