Zeljka Jutric1, W Cory Johnston1, Jan Grendar1, Leah Haykin2, Connor Mathews3, Liv K Harmon4, Jian Shen3, Hejin P Hahn4, David L Coy4, Maria A Cassera2, W Scott Helton4, Flavio G Rocha4, Ronald F Wolf5, Paul D Hansen5, Chet W Hammill5, Adnan A Alseidi4, Pippa H Newell6. 1. Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA. 2. Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA. 3. Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA. 4. Virginia Mason Medical Center, Seattle, WA, USA. 5. Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA. 6. Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Department of General, Thoracic and Vascular Surgery, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N50, Portland, OR 97213, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA. Electronic address: philippa.newell@gmail.com.
Abstract
BACKGROUND: Preoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed. METHODS: Risk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120). RESULTS: Forty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density (P = .0013), but density did not predict pancreatic fistula (P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis. CONCLUSIONS: This multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.
BACKGROUND: Preoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed. METHODS: Risk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120). RESULTS: Forty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density (P = .0013), but density did not predict pancreatic fistula (P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis. CONCLUSIONS: This multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.