Risk Prediction of Postoperative Pancreatic Fistula After Open Pancreatoduodenectomy Using Objective Indicators Obtained From Preoperative Images

Background and Objectives Postoperative pancreatic fistula (POPF) is a serious complication following Pancreatoduodenectomy (PD). Accurate prediction of clinically relevant POPF (CR‐POPF) is essential to reduce morbidity. Identifying objective, easily measurable preoperative risk factors may improve patient outcomes. Therefore, we aimed to identify significant predictive risk factors for CR‐POPF. Methods We retrospectively analyzed data from 143 patients who underwent PD. Preoperative computed tomography (CT) or magnetic resonance cholangiopancreatography (MRCP) was used to measure the main pancreatic duct (MPD) diameter, the distance from the peritoneum to the anterior surface of the pancreas (PTP), and the abdominal wall thickness (AWT). The PTP/AWT ratio was calculated as a surrogate marker for the visceral‐to‐subcutaneous fat ratio (V/S ratio). The liver‐to‐pancreas mean CT attenuation ratio (late/early phase; L/E ratio) was also assessed. Univariate and multivariable analyses were performed to identify risk factors for CR‐POPF. Results CR‐POPF occurred in 33 (23.1%) patients. Multivariable analysis identified V/S ratio ≥ 3.5 (OR: 3.55, p = 0.041), and L/E ratio < 1.2 (OR: 6.07, p = 0.004) as independent risk predictors of CR‐POPF. Conclusions Simple, objective parameters from preoperative CT or MRCP images may help predict CR‐POPF. Accurate risk assessment and early intervention may reduce complications and improve postoperative outcomes.