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Original Article
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| Can preoperative computed tomography scan predict the occurrence of a pancreatic anastomotic leak: A prospective study with clinical, radiological and pathological co-relation | ||||||
| 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 | ||||||
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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. | ||||||
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| Naragund AV, Prabhu RY, Hira P, Karegar MM, Khuroo SF, Bapat RD, Kantharia C, Supe AN. Can preoperative computed tomography scan predict the occurrence of a pancreatic anastomotic leak: A prospective study with clinical, radiological and pathological co-relation. Int J Hepatobiliary Pancreat Dis 2016;6:48–56. |
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Abstract
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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 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 delayed-phase 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. | |
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Keywords:
Fibrosis, Leak, Pancreas, Pancreaticoduodenectomy
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Author Contributions
Adithya V. Naragund – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Prabhu R. Y. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Hira P. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Karegar M. M. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Khuroo S. F. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Bapat R. D. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Kantharia C. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Supe A. N. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Adithya V. Naragund et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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