Significance of Preoperative Pancreatic MRI Findings in Predicting Factors for Postoperative Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Cancer: A Retrospective Study

Abstract Background: Postoperative pancreatic fistula (POPF) is the most serious complication of distal pancreatectomy (DP). For patients with pancreatic cancer (PC), POPF can have a negative effect on both short- and long-term prognoses. This study aimed to identify clinical outcomes of POPF after DP for PC and predictive factors for POPF.Methods: This retrospective, single-institution study comprised 48 patients with PC who underwent open DP (excluding simultaneous resection of other organs and other pancreatic diseases) between January 2010 and December 2020 at the Gifu University Hospital. We statistically analyzed patient-, pancreas-, cancer-, and surgery-related factors for predicting outcomes and risk factors for POPF. Results: According to the International Study Group of Pancreatic Fistula (ISGPF) definition and grading, 11 (22.9%) of 48 patients had POPF grades B and C. Among 22 related factors, POPF was significantly associated with pancreatic width (p = 0.04) and the pancreas-to-muscle signal intensity ratio (SIR) on T1-weighted magnetic resonance imaging (MRI, p = 0.02) in univariate analysis. In multivariate analysis, both pancreatic width (≥23 mm, odds ratio [OR] 9.37; 95% confidence interval [CI] 1.22–202.40; p = 0.03) and SIR on T1-weighted MRI (≥1.37, OR 17.10; 95% CI 2.38–359.04; p = 0.003) were identified as independent predictive factors for POPF. Conclusion: Pancreatic width and pancreas-to-muscle SIR on T1-weighted MRI significantly correlated with POPF after DP for PC. These parameters may be potential imaging biomarkers for predicting POPF in pancreatic surgery.