Risk Factors for Pancreatic Anastomotic Leakage: The Significance of Preoperative Dynamic Magnetic Resonance Imaging of the Pancreas as a Predictor of Leakage

Authors:
  • TKTamotsu Kuroki
    Tamotsu Kuroki
  • RTRyuji Tsutsumi
    Ryuji Tsutsumi
  • KFKenzo Fukuda
    Kenzo Fukuda
  • AKAmane Kitasato
    Amane Kitasato
  • TATomohiko Adachi
    Tomohiko Adachi
  • TMTakehiro Mishima
    Takehiro Mishima
  • TKTakashi Kanematsu
    Takashi Kanematsu
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Abstract
The histologic degree of pancreatic fibrosis can be assessed preoperatively by using the time-signal intensity curve (TIC) of the pancreas obtained from dynamic magnetic resonance imaging. To identify risk factors for postoperative pancreatic anastomotic leakage and to assess the impact of pancreatic TIC on this complication, 89 patients who underwent a pancreatic head resection with an end-to-side pancreaticojejunostomy between December 1998 and August 2005 were retrospectively reviewed. The pancreatic TIC profiles were classified into 3 types: type I, indicating a normal pancreas without fibrosis; and types II and III indicating fibrotic pancreas. Pancreaticojejunal anastomotic leakage occurred in 14 patients (16%). In a univariate analysis, pancreatic texture (hard, 3% versus intermediate, 20% versus soft, 23%; p = 0.046), pancreatic duct size (> 3 mm, 8% versus 6.0%) than in those with a normal hemoglobin A1c level. Pancreatic TIC from dynamic MRI provides reliable information for predicting risk of pancreatic anastomotic leakage after pancreatic head resection. Especially in patients with type I pancreatic TIC, the presence of uncontrolled diabetes is considered a primary risk factor for postoperative pancreatic leakage.

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