Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?

Table 1 Comparison of demographic, clinical and preoperative radiological parameters between patients with and without clinically relevant postoperative pancreatic fistula

Parameter	CR-POPF, n = 18	No CR-POPF, n = 43	P value
Age in yr, mean ± SD	53.7 ± 10.8	54.7 ± 11.5	0.746
Sex, n (%)
Male	10 (55.6)	28 (65.1)	0.567
Female	8 (44.4)	15 (34.9)
BMI in kg/m2, mean ± SD	21.1 ± 4.4	20.1 ± 3.9	0.388
Weight loss, n (%)	15 (83.3)	32 (74.4)	0.525
Comorbidities, n (%)	11 (61.1)	22 (51.2)	0.578
Hemoglobin in gm%, mean ± SD	10.7 ± 1.4	10.8 ± 1.5	0.735
Preoperative serum bilirubin (mg/dL), median (IQR)	2 (1.8-6)	3 (1-7)	0.848
Preoperative biliary drainage, n (%)	10 (55.6)	22 (51.2)	0.786
Pancreatic attenuation index, mean ± SD	0.8 ± 0.2	0.8 ± 0.2	0.741
Pancreatic enhancement ratio, mean ± SD	0.6 ± 0.2	0.8 ± 0.4	0.006

CR-POPF: Clinically relevant postoperative pancreatic fistula; gm: Gram; IQR: Inter quartile range; SD: Standard deviation.

Table 2 Correlation between preoperative radiological indices and histopathological pancreatic neck fat fraction and fibrosis

	Pancreatic attenuation index	Pancreatic enhancement ratio	Pancreatic fat fraction	Fibrosis score
Pancreatic attenuation index	-	-0.27 a	0.21	-0.20
Pancreatic enhancement ratio	-0.27a	-	-0.10	0.50 b
Pancreatic fat fraction	0.21	-0.10	-	-0.12
Fibrosis score	-0.20	0.50 b	-0.12	-

^aCorrelation is significant at the 0.05 level (2-tailed).

^bCorrelation is significant at the 0.01 level (2-tailed).

Table 3 Comparison of perioperative and pathological parameters between patients with and without clinically relevant postoperative pancreatic fistula

Parameter	CR-POPF, n = 18	No CR-POPF,n = 43	P value
Operative time in min, mean ± SD	521.9 ± 123	463.9 ± 101.2	0.275
Blood loss in mL, median (IQR)	550 (350-725)	475 (350-800)	0.830
Intraoperative blood transfusion, n (%)	6 (33.3)	17 (39.5)	0.775
Pancreatic texture, n (%)
Firm	1 (5.6)	20 (47.6)	0.002
Soft	17 (94.4)	22 (52.4)
Pancreatic duct size in mm, mean ± SD	2.8 ± 1.1	3.4 ± 1.6	0.169
Surgical approach, n (%)
Open	9 (50)	24 (55.8)
Laparoscopic	6 (33.3)	12 (27.9)
Robot assisted	3 (16.7)	7 (16.3)	0.927
Delayed gastric emptying, n (%)	15 (83.3)	13 (30.2)	< 0.001
Postpancreatectomy hemorrhage, n (%)	3 (16.7)	4 (9.3)	0.662
Intra-abdominal abscess, n (%)	9 (50)	1 (2.3)	< 0.001
Hospital stay in d, mean ± SD	26.8 ± 13.9	9.6 ±.6	0.001
Pathology, n (%)
Malignant	17 (94.4)	35 (81.4)
Benign	1 (5.6)	8 (18.6)	0.259
Fat fraction, n (%)
Absent	6 (33.3)	20 (46.5)
Mild	9 (50.0)	17 (39.6)	0.669
Moderate	3 (16.7)	6 (13.9)
Fibrosis score, n (%)
Weak	16 (88.9)	27 (62.8)
Heavy	2 (11.1)	16 (37.2)	0.063

CR-POPF: Clinically relevant postoperative pancreatic fistula; IQR: Inter quartile range; SD: Standard deviation.