Clinical Features of Postoperative Pancreatic Fistula After Pancreaticoduodenectomy in Patients With a Hard Pancreas: Focused on Estimated Functional Remnant Pancreatic Volume

Background This study aimed to evaluate the association between computed tomography (CT) findings and the development of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) in patients with a hard pancreas. Methods The medical records of 96 patients who underwent PD and had a hard pancreas were retrospectively reviewed. The estimated functional remnant pancreatic volume (eFRPV), which is a composite preoperative CT-derived parameter reflecting both pancreatic volume and attenuation, was evaluated. Additionally, pancreatic attenuation value (PAV), remnant pancreatic volume (RPV), and main pancreatic duct (MPD) were also assessed. Variables, including eFRPV, were compared between patients with and those without POPF after PD. Results Clinically relevant POPF was observed in seven (7.3%) patients. In the preoperative evaluable factors, only the eFRPV (33.3 HU·mL vs 70.8 HU·mL, P = .021) and PAV (32.6 HU vs 40.2 HU, P = .013) were associated with clinically relevant POPF. Remnant pancreatic volume and MPD were not significantly different between two groups. The area under the curve (AUC) was 0.764 for eFRPV and 0.783 for PAV. Although the AUCs for eFRPV and PAV were not significantly different ( P = .785), eFRPV showed higher specificity at the point corresponding to 100% sensitivity (62.5% vs 38.2%). Conclusions In patients with a hard pancreas, POPF following PD can be predicted using eFRPV assessed by preoperative CT.