Prediction of pancreatic anastomotic failure after pancreatoduodenectomy: The use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition

Yujiro Kirihara, Naoki Takahashi, Yasushi Hashimoto, Guido M. Sclabas, Saboor Khan, Toshiyuki Moriya, Junichi Sakagami, Marianne Huebner, Michael G. Sarr, Michael B. Farnell

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Objective:: To determine whether remnant pancreatic volume (RPV), subcutaneous/visceral adipose tissue(SAT/VAT) area, and skeletal muscle (SM) area calculated from preoperative computed tomography (CT) can predict the occurrence of pancreatic anastomotic failure (PAF) after pancreatoduodenectomy (PD). Background:: Increased body mass index, small main pancreatic duct, and soft pancreatic texture are well-established predictors of PAF after PD. The impact on PAF of anthropomorphic measurements, such as RPV and body composition, is unknown. METHODS:: In 173 patients undergoing PD from 2004 to 2009, cross sections of SAT/VAT/SM area were quantitated volumetrically, respectively, from preoperative CT. RPV was calculated from the CT as the sum of pancreatic tissue area to the left of the presumed pancreatic transection site. The predictive ability for multiple models using combinations of body mass index, RPV, SAT/VAT area, SM area, main pancreatic duct size, and pancreatic gland texture was described using a concordance index (c-index). RESULTS:: Clinically relevant PAF occurred in 22 patients (13%). Multivariate logistic regression analysis identified RPV (P = 0.0012), VAT area (P = 0.0003), and SM area (P = 0.0006) as independent predictors of PAF. Using previously identified risk factors, the best 2-predictor model (body mass index and pancreatic duct size) resulted in a c-index of 0.748. Using anthropomorphic factors, however, the 2-predictor model using VAT and SM areas revealed a superior c-index of 0.959. CONCLUSIONS:: Our 2-predictor model using VAT area and SM area based on volumetric quantification using preoperative CT may offer clinical benefit as an objective prognostic measure to predict clinically relevant PAF after PD.

Original languageEnglish (US)
Pages (from-to)512-519
Number of pages8
JournalAnnals of Surgery
Volume257
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Pancreaticoduodenectomy
Body Composition
Skeletal Muscle
Tomography
Pancreatic Ducts
Body Mass Index
Intra-Abdominal Fat
Subcutaneous Fat
Logistic Models
Regression Analysis

Keywords

  • pancreatic anastomotic failure
  • pancreatoduodenectomy
  • quantitative CT
  • skeletal muscle
  • visceral adipose tissue

ASJC Scopus subject areas

  • Surgery

Cite this

Prediction of pancreatic anastomotic failure after pancreatoduodenectomy : The use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition. / Kirihara, Yujiro; Takahashi, Naoki; Hashimoto, Yasushi; Sclabas, Guido M.; Khan, Saboor; Moriya, Toshiyuki; Sakagami, Junichi; Huebner, Marianne; Sarr, Michael G.; Farnell, Michael B.

In: Annals of Surgery, Vol. 257, No. 3, 03.2013, p. 512-519.

Research output: Contribution to journalArticle

Kirihara, Yujiro ; Takahashi, Naoki ; Hashimoto, Yasushi ; Sclabas, Guido M. ; Khan, Saboor ; Moriya, Toshiyuki ; Sakagami, Junichi ; Huebner, Marianne ; Sarr, Michael G. ; Farnell, Michael B. / Prediction of pancreatic anastomotic failure after pancreatoduodenectomy : The use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition. In: Annals of Surgery. 2013 ; Vol. 257, No. 3. pp. 512-519.
@article{49f0d37611024eceab2185ef7c2b3f85,
title = "Prediction of pancreatic anastomotic failure after pancreatoduodenectomy: The use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition",
abstract = "Objective:: To determine whether remnant pancreatic volume (RPV), subcutaneous/visceral adipose tissue(SAT/VAT) area, and skeletal muscle (SM) area calculated from preoperative computed tomography (CT) can predict the occurrence of pancreatic anastomotic failure (PAF) after pancreatoduodenectomy (PD). Background:: Increased body mass index, small main pancreatic duct, and soft pancreatic texture are well-established predictors of PAF after PD. The impact on PAF of anthropomorphic measurements, such as RPV and body composition, is unknown. METHODS:: In 173 patients undergoing PD from 2004 to 2009, cross sections of SAT/VAT/SM area were quantitated volumetrically, respectively, from preoperative CT. RPV was calculated from the CT as the sum of pancreatic tissue area to the left of the presumed pancreatic transection site. The predictive ability for multiple models using combinations of body mass index, RPV, SAT/VAT area, SM area, main pancreatic duct size, and pancreatic gland texture was described using a concordance index (c-index). RESULTS:: Clinically relevant PAF occurred in 22 patients (13{\%}). Multivariate logistic regression analysis identified RPV (P = 0.0012), VAT area (P = 0.0003), and SM area (P = 0.0006) as independent predictors of PAF. Using previously identified risk factors, the best 2-predictor model (body mass index and pancreatic duct size) resulted in a c-index of 0.748. Using anthropomorphic factors, however, the 2-predictor model using VAT and SM areas revealed a superior c-index of 0.959. CONCLUSIONS:: Our 2-predictor model using VAT area and SM area based on volumetric quantification using preoperative CT may offer clinical benefit as an objective prognostic measure to predict clinically relevant PAF after PD.",
keywords = "pancreatic anastomotic failure, pancreatoduodenectomy, quantitative CT, skeletal muscle, visceral adipose tissue",
author = "Yujiro Kirihara and Naoki Takahashi and Yasushi Hashimoto and Sclabas, {Guido M.} and Saboor Khan and Toshiyuki Moriya and Junichi Sakagami and Marianne Huebner and Sarr, {Michael G.} and Farnell, {Michael B.}",
year = "2013",
month = "3",
doi = "10.1097/SLA.0b013e31827827d0",
language = "English (US)",
volume = "257",
pages = "512--519",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Prediction of pancreatic anastomotic failure after pancreatoduodenectomy

T2 - The use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition

AU - Kirihara, Yujiro

AU - Takahashi, Naoki

AU - Hashimoto, Yasushi

AU - Sclabas, Guido M.

AU - Khan, Saboor

AU - Moriya, Toshiyuki

AU - Sakagami, Junichi

AU - Huebner, Marianne

AU - Sarr, Michael G.

AU - Farnell, Michael B.

PY - 2013/3

Y1 - 2013/3

N2 - Objective:: To determine whether remnant pancreatic volume (RPV), subcutaneous/visceral adipose tissue(SAT/VAT) area, and skeletal muscle (SM) area calculated from preoperative computed tomography (CT) can predict the occurrence of pancreatic anastomotic failure (PAF) after pancreatoduodenectomy (PD). Background:: Increased body mass index, small main pancreatic duct, and soft pancreatic texture are well-established predictors of PAF after PD. The impact on PAF of anthropomorphic measurements, such as RPV and body composition, is unknown. METHODS:: In 173 patients undergoing PD from 2004 to 2009, cross sections of SAT/VAT/SM area were quantitated volumetrically, respectively, from preoperative CT. RPV was calculated from the CT as the sum of pancreatic tissue area to the left of the presumed pancreatic transection site. The predictive ability for multiple models using combinations of body mass index, RPV, SAT/VAT area, SM area, main pancreatic duct size, and pancreatic gland texture was described using a concordance index (c-index). RESULTS:: Clinically relevant PAF occurred in 22 patients (13%). Multivariate logistic regression analysis identified RPV (P = 0.0012), VAT area (P = 0.0003), and SM area (P = 0.0006) as independent predictors of PAF. Using previously identified risk factors, the best 2-predictor model (body mass index and pancreatic duct size) resulted in a c-index of 0.748. Using anthropomorphic factors, however, the 2-predictor model using VAT and SM areas revealed a superior c-index of 0.959. CONCLUSIONS:: Our 2-predictor model using VAT area and SM area based on volumetric quantification using preoperative CT may offer clinical benefit as an objective prognostic measure to predict clinically relevant PAF after PD.

AB - Objective:: To determine whether remnant pancreatic volume (RPV), subcutaneous/visceral adipose tissue(SAT/VAT) area, and skeletal muscle (SM) area calculated from preoperative computed tomography (CT) can predict the occurrence of pancreatic anastomotic failure (PAF) after pancreatoduodenectomy (PD). Background:: Increased body mass index, small main pancreatic duct, and soft pancreatic texture are well-established predictors of PAF after PD. The impact on PAF of anthropomorphic measurements, such as RPV and body composition, is unknown. METHODS:: In 173 patients undergoing PD from 2004 to 2009, cross sections of SAT/VAT/SM area were quantitated volumetrically, respectively, from preoperative CT. RPV was calculated from the CT as the sum of pancreatic tissue area to the left of the presumed pancreatic transection site. The predictive ability for multiple models using combinations of body mass index, RPV, SAT/VAT area, SM area, main pancreatic duct size, and pancreatic gland texture was described using a concordance index (c-index). RESULTS:: Clinically relevant PAF occurred in 22 patients (13%). Multivariate logistic regression analysis identified RPV (P = 0.0012), VAT area (P = 0.0003), and SM area (P = 0.0006) as independent predictors of PAF. Using previously identified risk factors, the best 2-predictor model (body mass index and pancreatic duct size) resulted in a c-index of 0.748. Using anthropomorphic factors, however, the 2-predictor model using VAT and SM areas revealed a superior c-index of 0.959. CONCLUSIONS:: Our 2-predictor model using VAT area and SM area based on volumetric quantification using preoperative CT may offer clinical benefit as an objective prognostic measure to predict clinically relevant PAF after PD.

KW - pancreatic anastomotic failure

KW - pancreatoduodenectomy

KW - quantitative CT

KW - skeletal muscle

KW - visceral adipose tissue

UR - http://www.scopus.com/inward/record.url?scp=84873998391&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873998391&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e31827827d0

DO - 10.1097/SLA.0b013e31827827d0

M3 - Article

C2 - 23241871

AN - SCOPUS:84873998391

VL - 257

SP - 512

EP - 519

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -