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Preoperative Fistula Risk Prediction Using Computed Tomography Image Before Pancreatoduodenectomy

 Sung Hyun Kim  ;  Seung-Seob Kim  ;  Ho Kyoung Hwang  ;  Chang Moo Kang  ;  Jin-Young Choi  ;  Kyung Sik Kim  ;  Hyoung-Il Kim 
 ANNALS OF SURGICAL ONCOLOGY, Vol.30(12) : 7731-7737, 2023-11 
Journal Title
Issue Date
Computed tomography ; Hounsfield unit ; Pancreatic fistula ; Pancreaticoduodenectomy ; Prognosis
Background: Although many formulas for predicting postoperative pancreatic fistula (POPF) have been introduced, POPF is generally predicted during pancreatic surgery due to pancreatic texture. This study was designed to verify the correlation between Hounsfield units (HU) and pancreatic texture and to suggest a fistula risk score (FRS) that can be used before surgery.

Methods: Data from 545 patients who underwent pancreatoduodenectomy for malignant disease between January 2008 and December 2019 were retrospectively reviewed. The HU level of the pancreas was measured, and odds ratio (OR) of the HU for POPF was analyzed. Additionally, the assessed HU was compared with the pancreatic texture (soft vs. hard) and calculated cutoff level. Finally, the preoperatively chosen pancreatic texture according to HU level was applied to the FRS formula (preoperative-FRS: p-FRS), and the results were compared with a previously reported FRS formula (updated alternative-FRS: ua-FRS).

Results: The Hounsfield unit levels were correlated with clinically relevant POPF (CR-POPF) (odds ratio [OR]: 1.04 (1.01-1.07), p = 0.015). In the receiver operating characteristic curve, the HU showed significant prediction potential for pancreatic texture (area under the curve [AUC]: 0.744, p < 0.001). The p-FRS also showed acceptable results in predicting CR-POPF (AUC = 0.702, p < 0.001). There was no statistically significant difference in the DeLong's test compared with the ua-FRS (p = 0.314). In the Hosmer-Lemeshow test, observed probabilities were correlated with predicted probabilities (p = 0.596).

Conclusions: The HU level on preoperative computed tomography (CT) is a predictive factor for POPF and could represent for pancreatic texture.
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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, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Kim, Sung Hyun(김성현) ORCID logo https://orcid.org/0000-0001-7683-9687
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
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