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European Radiology

, Volume 29, Issue 5, pp 2399–2407 | Cite as

Multidetector CT findings differ between surgical grades of pancreatic fistula after pancreaticoduodenectomy

  • Hyo-jae Lee
  • Jin Woong KimEmail author
  • Young Hoe Hur
  • Byung Kook Lee
  • Sung Bum Cho
  • Eu Chang Hwang
  • Seung Jin Lee
  • Eun Ju Yoon
  • Hyun Ju Seon
Hepatobiliary-Pancreas
  • 120 Downloads

Abstract

Objectives

To define and correlate multidetector CT (MDCT) findings of pancreatic fistula after pancreaticoduodenectomy with surgical grading based on the 2016 Revised International Study Group of Pancreatic Fistula (ISGPF) classification.

Methods

Between May 2011 and December 2016, 235 patients with periampullary tumor underwent pancreaticoduodenectomy and postoperative MDCT. Patients were classified into three groups (clinically no pancreatic fistula (cNo-PF), grade B, and grade C) according to the ISGPF classification. MDCT images were retrospectively evaluated by two radiologists in consensus for the presence of pancreaticojejunostomy (PJ) dehiscence, PJ dehiscence diameter, PJ defect, acute necrotic collection (ANC), peripancreatic fluid collection, and imaging findings of complications. Categorical MDCT findings were compared among the three groups using Pearson’s chi-square test, and PJ dehiscence diameter was compared using the Kruskal–Wallis test.

Results

There was no significant difference in patient demographics among the groups (cNo-PF = 133, grade B = 68, and grade C = 34), but the MDCT findings were significantly different regarding the presence of PJ dehiscence (p < 0.001), PJ defect (p < 0.001), ANC (p = 0.002), and imaging findings of total complications (p < 0.001). The diameters of PJ dehiscence were significantly different among the groups (cNo-PF [0.42 ± 1.54 mm], grade B [1.47 ± 2.33 mm], and grade C [5.38 ± 6.45 mm]) (p < 0.001).

Conclusion

With respect to the presence of PF, postoperative MDCT findings may differ between surgical grading based on the ISGPF classification.

Key Points

Regarding the presence of pancreatic fistula, the postoperative multidetector CT findings correlate well with surgical grading based on the International Study Group of Pancreatic Fistula classification.

• Multidetector CT may provide reliable information to suggest pancreatic fistula after pancreaticoduodenectomy.

Keywords

Pancreaticoduodenectomy Pancreatic fistula Pancreaticojejunostomy Postoperative complications 

Abbreviations

ANC

Acute necrotic collection

AUC

Area under the receiver operating characteristic curve

CI

Confidence interval

cNo-PF

Clinically no pancreatic fistula

ISGPF

2016 Revised International Study Group of Pancreatic Fistula

MDCT

Multidetector CT

PF

Pancreatic fistula

PJ defect

Pancreaticojejunostomy defect

PJ dehiscence

Pancreaticojejunostomy dehiscence

POP

Postoperative pancreatitis

POPF

Postoperative pancreatic fistula

PPPD

Pylorus-preserving pancreaticoduodenectomy

Notes

Funding

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2017R1D1A3B04033613).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Jin Woong Kim.

Conflict of interest

Jin Woong Kim, MD, PhD, has received research grants from the National Research Foundation of Korea (NRF) (No. 2017R1D1A3B04033613). Hyo-jae Lee, Young Hoe Hur, Byung Kook Lee, Sung Bum Cho, Eu Chang Hwang, Seung Jin Lee, Eun Ju Yoon, and Hyun Ju Seon declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Byung Kook Lee and Eu Chang Hwang kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (No.: CNUHH-2017-140).

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyChonnam National University Hwasun Hospital and Chonnam National University Medical SchoolGwangjuRepublic of Korea
  2. 2.Department of RadiologyChosun University Hospital and Chosun University College of MedicineGwangjuRepublic of Korea
  3. 3.Department of Hepato-Pancreato-Biliary SurgeryChonnam National University Hwasun Hospital and Chonnam National University Medical SchoolGwangjuRepublic of Korea
  4. 4.Department of Emergency MedicineChonnam National University Hwasun Hospital and Chonnam National University Medical SchoolGwangjuRepublic of Korea
  5. 5.Department of Internal MedicineChonnam National University Hwasun Hospital and Chonnam National University Medical SchoolGwangjuRepublic of Korea
  6. 6.Department of UrologyChonnam National University Hwasun Hospital and Chonnam National University Medical SchoolGwangjuRepublic of Korea

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