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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2023

25-07-2023 | Computed Tomography | Pancreatic Tumors

Preoperative Fistula Risk Prediction Using Computed Tomography Image Before Pancreatoduodenectomy

Authors: Sung Hyun Kim, MD, MS, Seung-seob Kim, MD, Ho Kyoung Hwang, MD, PhD, Chang Moo Kang, MD, PhD, Jin-Young Choi, MD, PhD, Kyung Sik Kim, MD, PhD, Hyoung-Il Kim, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2023

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Abstract

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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Metadata
Title
Preoperative Fistula Risk Prediction Using Computed Tomography Image Before Pancreatoduodenectomy
Authors
Sung Hyun Kim, MD, MS
Seung-seob Kim, MD
Ho Kyoung Hwang, MD, PhD
Chang Moo Kang, MD, PhD
Jin-Young Choi, MD, PhD
Kyung Sik Kim, MD, PhD
Hyoung-Il Kim, MD, PhD
Publication date
25-07-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-13969-4

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