Pancreas-visceral fat CT value ratio and serrated pancreatic contour are strong predictors of postoperative pancreatic fistula after pancreaticojejunostomy

• Material Type: 博士論文
• Title: Pancreas-visceral fat CT value ratio and serrated pancreatic contour are strong predictors of postoperative pancreatic fistula after pancreaticojejunostomy
• Author/Editor: Kusafuka, Tomoki
• Author Heading: Kusafuka, Tomoki
• Publication, Distribution, etc.: 三重大学
• Publication Date: 2020-09-16
• Publication Date (W3CDTF): 2020-09-16
• Degree grantor/type: 三重大学
• Date Granted: 2020-09-16
• Date Granted (W3CDTF): 2020-09-16
• Dissertation Number: 甲医学第2033号
• Degree Type: 博士(医学)
• Conferring No. (Dissertation): 甲医学第2033号
• Text Language Code: eng
• Alias of Author: クサフカ, トモキ; 草深, 智樹
• Subject Heading: BMI; albumin; pancreatic parenchymal CT value; visceral fat CT value
• Target Audience: 一般
• Note (General): application/pdf; Background: Our aim is to elucidate the true preoperative risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD), making it possible to select POPF high-risk patients preoperatively regardless of intraoperative pancreatic consistency judged by the surgeon’s hand.Methods: Among the 298 patients who underwent PD with pancreaticojejunostomy from 2007 to 2016, 262 patients had preoperative CT configurations that could be precisely evaluated. Risk factor analyses were conducted using various perioperative factors, including preoperative CT findings, such as CT values of the pancreas, pancreas-visceral fat CT value ratio and pancreatic outer contour. Pancreatic outer contour was further divided into smooth- (smooth interlobular) and serrated-type contours (feathery, irregular interlobular) by preoperative CT.Results: In terms of the incidence of POPF, among the 262 patients, POPF grade B/C was found in 27 (10.3%): grade B in 23 (8.8%) and grade C in 4 (1.5%). According to multivariate analysis, a high pancreas-visceral fat CT value ratio (p=0.002), serratedtype contour (p=0.02) and no history of chemoradiotherapy (p=0.019) were identified as independent risk factors for POPF grade B/C. Even in patients with soft pancreas, the incidence of POPF grade B/C was 0% (0/57) in patients with a pancreas-visceral fat CT value ratio of less than -0.4 and smooth-type contour, whereas the incidence was markedly high (45.0%, 9/20) in patients with a pancreas-visceral fat CT value ratio of -0.4 or greater and serrated-type contour, indicating that patients with soft pancreas should be categorized into POPF high-risk and low-risk groups according to preoperative CT scan results.Conclusions: The pancreas-visceral fat CT value ratio and serrated-type pancreas are useful markers to preoperatively identify true POPF high-risk groups in patients undergoing PD, regardless of the pancreatic texture judged intraoperatively.; 本文/Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan; 37p
• DOI: info:doi/10.1186/s12893-020-00785-w; https://doi.org/info:doi/10.1186/s12893-020-00785-w
• Persistent ID (NDL): info:ndljp/pid/11671780; https://dl.ndl.go.jp/pid/11671780
• Collection: 障害者向け資料
• Collection (Materials For Handicapped People:1): テキストデータ
• Collection (particular): 国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文; https://dl.ndl.go.jp/collections/A00014
• Acquisition Basis: 博士論文（自動収集）
• Date Accepted (W3CDTF): 2021-05-16T23:51:55+09:00
• Date Created (W3CDTF): 2021-01-05
• Format (IMT): application/pdf
• Access Restrictions: 国立国会図書館内限定公開
• Service for the Digitized Contents Transmission Service: 図書館・個人送信対象外
• Availability of remote photoduplication service: 可
• Periodical Title (URI): http://hdl.handle.net/10076/00019577; https://mie-u.repo.nii.ac.jp/records/13959
• Data Provider (Database): 国立国会図書館 : 国立国会図書館デジタルコレクション; https://dl.ndl.go.jp