Zhao Zhirong, Zhou Lichen, Han Li, Zhou Shibo, Tan Zhen, Dai Ruiwu
College of Medicine, Southwest Jiaotong University, Chengdu, China.
General Surgery Center, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China.
Heliyon. 2023 Feb 11;9(2):e13660. doi: 10.1016/j.heliyon.2023.e13660. eCollection 2023 Feb.
The clinically relevant postoperative pancreatic fistula (CR-POPF) is significantly correlated with a high post-pancreaticoduodenectomy (PD) mortality rate. Several studies have reported an association between visceral obesity and CR-POPF. Nevertheless, there are many technical difficulties and controversies in the measurement of visceral fat. The aim of this research was to determine whether the visceral pancreatic neck anterior distance (V-PNAD) was a credible predictor for CR-POPF.
We retrospectively analyzed the data of 216 patients who underwent PD in our center between January 2016 and August 2021. The correlation of patients' demographic information, imaging variables, and intraoperative data with CR-POPF was assessed. Furthermore, areas under the receiver operating characteristic curves for six distances (abdominal thickness, visceral thickness, abdominal width, visceral width, abdominal PNAD, V-PNAD) were used to identify the best imaging distance to predict POPF.
In the multivariate logistic analysis, V-PNAD ( < 0.01) was the most significant risk factor for CR-POPF after PD. Males with a V-PNAD >3.97 cm or females with a V-PNAD >3.66 cm were included into the high-risk group. The high-risk group had a higher prevalence of CR-POPF (6.5% vs. 45.1%, < 0.001), intraperitoneal infection (1.9% vs. 23.9%, < 0.001), pulmonary infection (3.7% vs. 14.1%, = 0.012), pleural effusion (17.8% vs. 33.8%, = 0.014), and ascites (22.4% vs. 40.8%, = 0.009) than the low-risk group.
Of all imaging distances, V-PNAD may be the most effective predictor of CR-POPF. Moreover, high-risk patients (males, V-PNAD >3.97 cm; females, V-PNAD >3.66 cm) have a high incidence of CR-POPF and poor short-term post-PD prognosis. Therefore, surgeons should perform PD carefully and take adequate preventive measures to reduce the incidence of pancreatic fistula when the patient has a high V-PNAD.
临床相关的术后胰瘘（CR-POPF）与胰十二指肠切除术后（PD）的高死亡率显著相关。多项研究报告了内脏肥胖与CR-POPF之间的关联。然而，内脏脂肪的测量存在许多技术困难和争议。本研究的目的是确定内脏胰腺颈部前距离（V-PNAD）是否是CR-POPF的可靠预测指标。
我们回顾性分析了2016年1月至2021年8月期间在本中心接受PD的216例患者的数据。评估了患者的人口统计学信息、影像学变量和术中数据与CR-POPF的相关性。此外，使用六个距离（腹部厚度、内脏厚度、腹部宽度、内脏宽度、腹部PNAD、V-PNAD）的受试者操作特征曲线下面积来确定预测POPF的最佳影像学距离。
在多因素逻辑分析中，V-PNAD（<0.01）是PD后CR-POPF的最显著危险因素。V-PNAD>3.97 cm的男性或V-PNAD>3.66 cm的女性被纳入高危组。高危组的CR-POPF患病率较高（6.5%对45.1%，<0.001），腹腔感染（1.9%对23.9%，<0.001），肺部感染（3.7%对14.1%，=0.012），胸腔积液（17.8%对33.8%，=0.014）和腹水（22.4%对40.8%，=0.009）均高于低危组。
在所有影像学距离中，V-PNAD可能是CR-POPF的最有效预测指标。此外，高危患者（男性，V-PNAD>3.97 cm；女性，V-PNAD>3.66 cm）的CR-POPF发生率较高，PD术后短期预后较差。因此，当患者的V-PNAD较高时，外科医生应谨慎进行PD，并采取充分预防措施以降低胰瘘发生率。
