Evaluating Pancreatic Factors using Preoperative Computed Tomography to Predict Pancreatic Fistula After Distal Pancreatectomy

Background: A postoperative pancreatic fistula (POPF) is a common and clinically relevant complication following distal pancreatectomy (DP). This study aimed to assess whether pancreatic factors, obtained with preoperative computed tomography (CT), may predict a clinical POPF after DP. Methods: One hundred and ten patients were retrospectively assessed to determine the association between clinical POPF and clinicopathological data and imaging data from preoperative CT. Evaluations included the thickness of the pancreatic cut-line (TPC), main pancreatic duct (MPD) dilation, and pancreatic index (PI), which was calculated with the pancreas/spleen CT density ratio. Results: Clinical POPF occurred in 22 (20%) patients. Univariate analysis showed that TPC and extrapancreatic malignancy were significantly associated with clinical POPF after DP; PI and MPD dilation were not. A 15.35-mm cutoff value for TPC was determined according to the receiver operating characteristic (ROC) curve. TPC ≥ 15.4 mm was identified as a significant independent risk factor of clinical POPF in multivariate analyses (odds ratio 28.41; P <0.001). In the subgroup of thick pancreatic cut-line, all four patients with dilated MPD developed clinical POPF; there was no statically significant difference compared with non-dilated MPD. Conclusions: PI cannot predict the occurrence of clinical POPF after DP, for which TPC is a significant risk factor. When a thick pancreatic cut-line coexists with a dilated MPD, the clinical POPF rate may further increase.