Prediction of postpancreatoduodenectomy pancreatic fistula with the use of computer tomography

Aim. To reveal and evaluate opportunities of preoperative computer tomography (CT) for pancreatic fistula (PF) prediction after pancreatoduodenectomy.

Materials and methods. In 2005 International Study Group on Pancreatic Fistula (ISGPF) developed grading criteria for PF, including asymptomatic biochemical (Grade A), that could be treated conservatively, and clinically relevant (Grade B, Grade C), with consecutive active surgical treatment. For now ISGPF definition of PF is widely accepted. We review the literature since 2005 for original articles in English describing quantitive assessment of the pancreatic parenchyma using CT with histological validation. Low sample trials (<10 cases) were excluded.

Results. Three original publications met the inclusion criteria. Fatty and fibrosis infiltration of the pancreatic parenchyma assessed by preoperative CT revealed statistically significant correlation with PF rate.

Conclusion. Preoperative CT offers accurate prediction opportunities for postoperative pancreatic fistula and may help caregivers to set up protocols for a strict and early detection of warning clinical signs, to tailor the clinical management of different risk classes, or to select high-risk patients who might be excluded from surgical resection. This would also improve patient selection for relevant research protocols and facilitate a more definitive assessment of collected data related to surgical outcomes, across different institutions and surgeons, and even among different surgeries, in either single-institution or multi-center trials that involve pancreatic surgery.

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