Miyamoto Ryoichi, Oshiro Yukio, Sano Naoki, Inagawa Satoshi, Ohkohchi Nobuhiro
Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
Division of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation, Department of Surgery, University of Tsukuba, Tsukuba, Japan.
Gastrointest Tumors. 2019 Feb;5(3-4):90-99. doi: 10.1159/000495406. Epub 2018 Dec 12.
Postoperative pancreatic fistula (POPF) is a serious complication that can occur following pancreaticoduodenectomy (PD). Recent studies suggest that remnant pancreatic volume (RPV) values from preoperative multidetector computed tomography (MDCT) are highly predictive of POPF. We performed three-dimensional (3D) surgical simulation of PD including RPV measurements. The aim of this study was to determine whether 3D-measured RPV is predictive of POPF after PD.
We used the SYNAPSE VINCENT® medical imaging system (Fujifilm Medical Co., Ltd., Tokyo, Japan) to construct 3D images after integrating MDCT and magnetic resonance cholangiopancreatography images. RPV was measured using this 3D image, which simulated actual intraoperative pancreatic parenchymal remnant volume. Ninety-one patients who underwent PD were retrospectively enrolled. Using multivariate analysis, RPV and other well-known POPF risk factors were independently assessed.
Multivariate analysis identified high RPV values (hazard ratio [HR] = 8.41, = 0.01), pancreatic duct diameter < 3.0 mm (HR = 5.48, < 0.01), no pathological fibrosis (HR = 3.41, < 0.01), and body mass index > 25 kg/m (HR = 1.53, = 0.02) as independent risk factors for POPF.
The present study indicates that preoperative 3D-measured RPV is predictive of POPF after PD.
术后胰瘘（POPF）是胰十二指肠切除术（PD）后可能发生的一种严重并发症。近期研究表明，术前多排螺旋计算机断层扫描（MDCT）测得的残余胰腺体积（RPV）值对POPF具有高度预测性。我们对PD进行了包括RPV测量在内的三维（3D）手术模拟。本研究的目的是确定3D测量的RPV是否可预测PD术后的POPF。
我们使用SYNAPSE VINCENT®医学成像系统（日本东京富士胶片医疗株式会社），在整合MDCT和磁共振胰胆管造影图像后构建3D图像。使用该3D图像测量RPV，其模拟了实际术中胰腺实质残余体积。对91例行PD的患者进行回顾性纳入研究。采用多因素分析独立评估RPV和其他已知的POPF危险因素。
多因素分析确定高RPV值（风险比[HR]=8.41，P=0.01）、胰管直径<3.0 mm（HR=5.48，P<0.01）、无病理性纤维化（HR=3.41，P<0.01）以及体重指数>25 kg/m²（HR=1.53，P=0.02）为POPF的独立危险因素。
本研究表明，术前3D测量的RPV可预测PD术后的POPF。
