2019 Volume 52 Issue 9 Pages 485-493
Purpose: To investigate whether the ratio of the CT value in future pancreas remnant to spleen (remnant P/S ratio) can predict the occurrence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). Materials and Methods: Our study is a retrospective study. We selected 52 patients who underwent DP between 2007 and 2017 in our hospital. We examined the relationship between preoperative factors (age, gender, preoperative albumin score, prognostic nutritional index (PNI), visceral fat area, subcutaneous fat area, thickness of pancreas, CT value of future pancreas remnant, and P/S ratio), intraoperative factors (blood loss, operative time, blood transfusion, the way of pancreatic stump closure) and occurrence of POPF by using statistical method. We defined POPF if severity was Grade 2 or higher according to the Clavien-Dindo classification. CT value in both future pancreas remnant and spleen parenchyma was measured using unenhanced CT. We selected 5 points (not overlapping nearby vessels and other organs) and measured CT value, and calculated the median score for each organ. Result: POPF after DP occurred in 14 cases (26.9%) and median postoperative hospital stay was 19 days. In univariate analysis, younger age (P=0.006), high CT value of future pancreas remnant (P=0.0313), and high P/S ratio (P=0.0187) showed a significant relationship with the occurrence of POPF. In histopathological examination, the grade of degenerative fatty change in pancreatic cut margin and CT value of future pancreas remnant and P/S ratio revealed a significant relationship. Conclusion: Measurement of CT value ratio of future pancreas remnant and P/S ratio may predict the occurrence of POPF after DP.
