Early protocol computed tomography scan in asymptomatic high-risk patients diagnosed with pancreatic fistula after pancreatoduodenectomy: results of a prospective audit
Shams, Mohamed A Rehman, Saad Joshi, Kunal Raza, Syed S Chatzizacharias, Nikolaos Bartlett, David C Dasari, Bobby V M Marudanayagam, Ravi Roberts, Keith J Sutcliffe, Robert P
Shams, Mohamed A
Rehman, Saad
Joshi, Kunal
Raza, Syed S
Chatzizacharias, Nikolaos
Bartlett, David C
Dasari, Bobby V M
Marudanayagam, Ravi
Roberts, Keith J
Sutcliffe, Robert P
Abstract
Objective: We hypothesized that protocol computed tomography scans in selected patients diagnosed with postoperative pancreatic fistula after pancreatoduodenectomy may lead to earlier diagnosis and/or treatment of clinically relevant postoperative pancreatic fistula.
Methods: Since September 2022, postoperative management after pancreatoduodenectomy in our center was modified to include protocol computed tomography scan in asymptomatic postoperative pancreatic fistula patients at high risk of progressing to clinically relevant-postoperative pancreatic fistula (clinically relevant score ≥5; based on sex and postoperative day 3 laboratory data). The effect of this practice was evaluated by comparing outcomes between historical (Jan 2020-Aug 2022) and prospective cohorts (Sept 2022-Dec 2024). Data collected included number/timing of computed tomography scans, type/timing of invasive interventions, and short-term outcomes.
Results: One hundred forty-nine of 437 patients (34.1%) developed postoperative pancreatic fistula after pancreatoduodenectomy. Clinically relevant scores were available for 139 postoperative pancreatic fistula patients. Patients with a clinically relevant score ≥5 were more likely to progress to clinically relevant-postoperative pancreatic fistula compared with those with a score of <5 (72.7% vs 41.1%; P< .001). Thirty postoperative pancreatic fistula patients in the prospective cohort had clinically relevant scores ≥5, of whom 6 (20%) had clinically indicated computed tomography scans because of clinical deterioration, whereas 23 (76.7%) were asymptomatic and underwent protocol computed tomography scans on median postoperative day 4 (compared with postoperative day 8 in the historical cohort; P < .001). Abnormal findings were present on 17 of 23 (73.9%) protocol computed tomography scans and resulted in immediate or delayed radiological drainage in 6 patients. Fluid collection on protocol computed tomography was significantly associated with the need for radiological drainage at any time after pancreatoduodenectomy (100% vs 27.3%; P= .009). In high-risk patients, invasive intervention (B3 and C) was more frequent in the prospective cohort (53.3% vs 22.2%; P= .26), but there were no differences in hospital stay or 90-day mortality.
Conclusion: Implementation of protocol computed tomography scans in high-risk postoperative pancreatic fistula patients after pancreatoduodenectomy was associated with earlier computed tomography scans and more invasive interventions, although this did not translate into improved outcomes. Larger, prospective studies are recommended.
Affiliations
Date
2026-05-06
Type
Article
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Citation
Shams MA, Rehman S, Joshi K, Raza SS, Chatzizacharias N, Bartlett DC, Dasari BVM, Marudanayagam R, Roberts KJ, Sutcliffe RP. Early protocol computed tomography scan in asymptomatic high-risk patients diagnosed with pancreatic fistula after pancreatoduodenectomy: Results of a prospective audit. Surgery. 2026 May 6;195:110219. doi: 10.1016/j.surg.2026.110219. Epub ahead of print.