The Risk Factors And The Value Of Pre-operation Computed Tomography In Predict The Pancreatic Fistula After Distal Pancreatectomy

Objective:To identify the risk factors of the pancreatic fistula after distal pancreatectomy and appraise the ability of predictive model which constructed by radiologic factors and clinicopathological findings.Methods:The clinicopathological findings and radiologic data from preoperative computed tomography(CT)of 213 patients who underwent distal pancreatectomy were analyzed retrospectively.CT images were applied to obtain the measures of the thickness of the pancreas,retro-renal fat thickness,liver and pancreas steatosis,single cross-sections of total fat area(TFA)/visceral fat area(VFA)/subcutaneous fat area(SFA)/psoas major muscle area/abdominal perimeter.The risk factors of pancreatic fistula after distal pancreatectomy were identified using logistic regression and propensity score methods.The ability of the predictive models based on different radiological factors were estimated by the receiver operating characteristic(ROC)curve.Result:Clinical-relevant postoperative pancreatic fistula(CR-POPF)occurred in 69patients(32.4%).The multivariate logistic regression analysis revealed that gender,age,abdominal surgery history,operation time,close methods of pancreatic stump,TFA,and abdominal perimeter were independent predictors of CR-POPF.Appling previous identified factors,three predictive models were made that were model A(clinicopathological risk factors),model B(clinicopathological risk factors and TFA),and model C(clinicopathological risk factors and abdominal perimeter).The AUC for model A,B,and C was 0.7325?0.7912 and 0.7880,respectively.Conclusion:Female gender,age?60 year-old,with abdominal surgery history,operation time>185 minutes,pancreatic stump closure with stapler,TFA>220 cm~2,and abdominal perimeter>85 cm were independent predictors of CR-POPF.Predictive model that included clinicopathological risk factors and radiologic factors could predict the CR-POPF more preciously.