Can preoperative computed tomography scan predict the occurrence of a pancreatic anastomotic leak: A prospective study with clinical, radiological and pathological co-relation

Aims: the pancreatic anastomosis after pancreaticoduodenectomy leaks in 5–30%. the accepted determinants of postoperative pancreatic fistula (POPF) are small pancreatic duct and soft pancreatic texture. Pancreatic fibrosis decreases the risk of POPF as seen in patients undergoing surgery for chronic pancreatitis. recent studies have attempted to use radiological methods to determine the pancreatic fibrosis and thus indirectly predict the risk of leak. Methods: Patients undergoing Pancreatico-enteric anastomosis underwent Adithya V. Naragund1, Prabhu R. Y.2, Hira P.3, Dr. Karegar M. M.4, Khuroo S. F.1, Bapat R. D.5, Kantharia C.6, Supe A. N.7 Affiliations: 1Registrar, Department of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital Mumbai; 2Associate Professor, Department of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai; 3Professor (Additional), Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai; 4Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai; 5Professor Emeritus, Department of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai; 6Professor and HOD, Department of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai; 7Dean and Professor of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai. Corresponding Author: Dr. Adithya V. Naragund, Registrar, Department of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 1058, 7th Cross, 7th Block, HMT Layout, Vidyaranyapura, Bangalore 560097; Email: [email protected] Received: 12 March 2016 Accepted: 11 June 2016 Published: 15 June 2016 a pancreatic protocol ct scan preoperatively. the enhancement ratio expressed as late phase/ early phase ratio (L/E ratio) was calculated as: (hepatic phase − unenhanced phase)/ (pancreatic phase − unenhanced phase) to indicate delayedphase enhancement. this ratio is used to predict the degree of pancreatic fibrosis. the pancreas was assessed by the surgeon intraoperatively. Pancreatic tissue obtained was analyzed for degree of pancreatic fibrosis. Pancreatic leak was classified as per IsGPF criteria. results: thirty-seven patients were included in the study, 21 underwent Frey’s/beger’s procedure and 16 patients underwent pancreaticoduodenectomy. the L/E ratio co-related well with the surgeons assessment of the pancreatic texture as well as the degree of pancreatic fibrosis. A ratio of 0.98 could predict leak with sensitivity of 75% and specificity of 93.1%, P value 0.0231. surgeon’s assessment of the pancreas was also a good predictor of a POPF. conclusion: L/E ratio calculation is simple and cost effective. the ability to predict a leak may have a significant impact on patient outcome. It helps in pre-operative patient counseling and warns surgeons about the presence of high risk factors for leak. this study validates the ability to co-relate radiology with histological fibrosis and incorporate them into clinical practice.