Computerized tomography on the 5th postoperative day helps distinguish grade C from grade B pancreatic fistula after pancreaticoduodenectomy for periampullary cancer

Background Grade C pancreatic fistula (PF) is the most dangerous complication after pancreaticoduodenectomy (PD) and had not been identified on the early postoperative day yet. In this study, we aimed to introduce a new approach to distinguish grade C from grade B PF by using features on the 5 th postoperative day’s computed tomography (CT). Materials and Methods A bicentric prospective cohort study was conducted from August 2021 to October 2023 at the University Medical Center (UMC) and Cho Ray Hospital, Vietnam. Patients who diagnosed pancreatic fistula and underwent a CT scan on the 5 th postoperative day were followed up within 90 days after PD. The characteristics of CT scan images were analyzed to differentiate both grades of PF. Results During 26 months, 77 patients with periampullary cancer underwent PD and met the criteria of the study (46 males, mean age: 57.1 ± 13.7). Of these, 52 patients had biochemical PF and 25 had CRPF (18 grade B PFs and 7 grade C PFs). Specifications on the 5 th postoperative day’s CT scan that can discriminate grade C from grade B included fluid diffusing throughout abdomen, retroperitoneal abscess, hematoma beneath the liver, size of the fluid collection next to the pancreas ( P = 0.031), and size of pancreatojejunostomy anastomosis dehiscence ( P = 0.045). Conclusions Features on CT scan could be used to identify grade C pancreatic fistula from the 5 th postoperative day. This result can help surgeons to make a plan for a careful follow-up and early reoperation for those patients.