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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 5/2017

01-05-2017

In Patients with a Soft Pancreas, a Thick Parenchyma, a Small Duct, and Fatty Infiltration Are Significant Risks for Pancreatic Fistula After Pancreaticoduodenectomy

Authors: Motokazu Sugimoto, Shinichiro Takahashi, Motohiro Kojima, Tatsushi Kobayashi, Naoto Gotohda, Masaru Konishi

Published in: Journal of Gastrointestinal Surgery | Issue 5/2017

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Abstract

Background

This study sought to characterize soft and hard pancreatic textures radiologically and histologically, and to identify specific risks in a soft pancreas associated with postoperative pancreatic fistula (POPF) formation after pancreaticoduodenectomy (PD).

Methods

Consecutive 145 patients who underwent PD at a single institution between January 2010 and May 2013 were studied. Pancreatic consistency was intraoperatively judged as soft or hard. Pancreatic configuration was assessed using preoperative CT. Histologic components of the pancreatic stump were evaluated using a morphometric analysis. Clinicopathologic parameters were then analyzed for the risk of clinically relevant POPF.

Results

Compared with patients with a hard pancreas (n = 66), those with a soft pancreas (n = 79) had a smaller main pancreatic duct (MPD) diameter and a larger parenchymal thickness on CT, had a smaller fibrosis ratio and a larger lobular ratio histologically, and developed clinically relevant POPF more frequently (P < 0.001 for all). In patients with a soft pancreas, an MPD diameter <2 mm, a parenchymal thickness ≥10 mm, a lobular ratio <75%, and a fat ratio ≥20% were independently associated with clinically relevant POPF (P < 0.010 for all).

Conclusion

In patients with a soft pancreas, a thick parenchyma, a small MPD, and fatty infiltration were strongly associated with clinically relevant POPF after PD.
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Metadata
Title
In Patients with a Soft Pancreas, a Thick Parenchyma, a Small Duct, and Fatty Infiltration Are Significant Risks for Pancreatic Fistula After Pancreaticoduodenectomy
Authors
Motokazu Sugimoto
Shinichiro Takahashi
Motohiro Kojima
Tatsushi Kobayashi
Naoto Gotohda
Masaru Konishi
Publication date
01-05-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 5/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3356-7

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