Postoperative Pancreatic Fistula After Pancreatoduodenectomy

作者：Ankur P. Choubey, Joséphine Magnin, Johan Gagnière, Abhishek Midya, John A. Steinharter, Rikiya Yamashita, Thomas Boerner, Richard Kinh Gian, Kevin C. Soares, Mithat Gönen, Jeffrey A. Drebin, T. Peter Kingham, Vinod P. Balachandran, Michael I. D’Angelica, Alice C. Wei, Amber L. Simpson, Jayasree Chakraborty, William R. Jarnagin · 发表于：Annals of Surgery · 年份：2025 · DOI：10.1097/sla.0000000000006991 · 被引用次数：2 · 研究领域：Pancreatic and Hepatic Oncology Research、Gallbladder and Bile Duct Disorders、Cholangiocarcinoma and Gallbladder Cancer Studies

OBJECTIVE: Assess the potential added benefit of radiomics to clinical models for predicting postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). SUMMARY OF BACKGROUND DATA: Radiomics extracts quantitative data from medical imaging based on enhancement patterns. Clinical applications of radiomics have been investigated in pancreas, lung, breast, and prostate cancers. METHODS: This single center retrospective study included all patients with available preoperative CT scan before PD from 2009-2021. Radiomic features that reflect heterogeneity in enhancement patterns were extracted from manually segmented future remnant pancreas. Clinical variables and radiomic features were used with random forest classifier to design five predictive models for grade B/C clinically relevant POPF (CR-POPF): preoperative (PreClin), intraoperative (IntraClin), radiomics alone (Rad), PreClin with radiomics (PreClin-Rad), and IntraClin with radiomics (IntraClin-Rad). Training data was randomly selected and comprised 70% (n=339) of the cohort, and the remaining 30% (n=145) was the test set. A prospective validation cohort (n=60) was also created. RESULTS: From 1855 eligible PD, all 234 with POPF were included, random sampling was used on the remainder to select 250 without POPF. In the test set, PreClin (AUC=0.74), IntraClin (AUC=0.78), and Rad (AUC=0.75) performed similarly. Best results were noted with combined models, AUC=0.82 for PreClin-Rad and AUC=0.84 for IntraClin-Rad. Th...