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von Ehrlich-Treuenstätt VH, Guenther M, Ilmer M, Knoblauch MM, Koch D, Clevert DA, Ormanns S, Klauschen F, Niess H, D'Haese J, Angele MK, Werner J, Renz BW. Preoperative ultrasound elastography for postoperative pancreatic fistula prediction after pancreatoduodenectomy: A prospective study. Surgery 2024; 175:491-497. [PMID: 38044240 DOI: 10.1016/j.surg.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/07/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Postoperative pancreatic fistulas are the most frequent major complications after pancreatoduodenectomy. The soft pancreatic texture is a critical, independent risk factor for postoperative pancreatic fistulas after pancreatoduodenectomy. The current gold standard for postoperative pancreatic fistula risk evaluation consists of the surgeon's intraoperative palpation of the pancreatic texture and, thus, lacks objectivity. In this prospective study, we used ultrasound-based shear-wave elastography, image data analysis, and a fistula risk score calculator to correlate the stiffness of pancreatic tissue with the occurrence of clinically relevant postoperative pancreatic fistulas. METHODS We included 100 patients with pancreatic pathologies (71% pancreatic ductal adenocarcinoma) and 100 healthy individuals who were preoperatively assessed via real-time tissue ultrasound-based shear-wave elastography on a Philips EPIQ 7 ultrasound device and had pancreatic parenchyma histologically evaluated with manually stained images. RESULTS We found a significant difference in the mean elasticity between the soft (1.22 m/s) and the hard pancreas group (2.10 m/s; P < .0001). The mean elasticity significantly correlated with the pancreatic fibrosis rate and the appearance of a postoperative pancreatic fistula after pancreatoduodenectomy. Low elasticity (≤1.2 m/s, mean) correlated with soft and high elasticity (>2.0 m/s, mean) with hard pancreatic parenchyma, as assessed by pathologic evaluation. Multivariate analysis revealed a mean elasticity of <1.3 m/s as a significant cut-off predictor for clinically relevant postoperative pancreatic fistulas (P = .003; Youden-Index = 0.6945). CONCLUSION Preoperative ultrasound-based shear-wave elastography is a feasible and objective clinical diagnostic modality in evaluating pancreatic tissue stiffness. A mean pancreatic elasticity of <1.3 m/s was a significant independent risk predictor of clinically relevant postoperative pancreatic fistulas after pancreatoduodenectomy.
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Affiliation(s)
| | - Michael Guenther
- Department of Pathology, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Matthias Ilmer
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Mathilda M Knoblauch
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Dominik Koch
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Dirk-Andre Clevert
- Department of Clinical Radiology, University Hospital, LMU Munich, Germany
| | - Steffen Ormanns
- Department of Pathology, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | | | - Hanno Niess
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Jan D'Haese
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Martin K Angele
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Bernhard W Renz
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany.
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