Pancreatic attenuation on computed tomography predicts pancreatic fistula after pancreaticoduodenectomy

Background: Some parameters using preoperative computed tomography (CT) have been evaluated to predict the development of pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The present retrospective study evaluated the predictive value of pancreatic attenuation for PF after PD. Methods: A retrospective review was conducted of the patients who underwent PD between January 2010 and December 2014. The pancreatic attenuation was measured in unenhanced preoperative CT images. Pre- and intraoperative variables were analyzed for the risk of PF after PD. Results: Of the 346 consecutive patients, PF occurred in 116 (34%). The pancreatic attenuation was significantly greater in patients with PF than in those without PF (median, 40.0 vs. 33.3 Hounsfield units [HU], P < 0.001). A multivariate analysis showed that a pancreatic attenuation >= 30.0 HU (odds ratio [OR], 3.72; P < 0.001), a body mass index >= 25.0 kg/m(2) (OR, 3.67; P < 0.001) and a diameter of the main pancreatic duct <3.0 mm (OR, 1.84; P = 0.034) were independent risk factors for PF after PD. Conclusion: The degree of pancreatic attenuation on preoperative CT images was significantly associated with PF, and a pancreatic attenuation >= 30.0 HU was an independent risk factor of PF after PD.