Risk Factors for Pancreatic Anastomotic Leakage: The Significance of Preoperative Dynamic Magnetic Resonance Imaging of the Pancreas as a Predictor of Leakage

BACKGROUND: The histologic degree of pancreatic fibrosis can be assessed preoperatively by using the time-signal intensity curve (TIC) of the pancreas obtained from dynamic magnetic resonance imaging. STUDY DESIGN: To identify risk factors for postoperative pancreatic anastomotic leakage and to assess the impact of pancreatic TIC on this complication, 89 patients who underwent a pancreatic head resection with an end-to-side pancreaticojejunostomy between December 1998 and August 2005 were retrospectively reviewed. The pancreatic TIC profiles were classified into 3 types: type I, indicating a normal pancreas without fibrosis; and types II and III indicating fibrotic pancreas. RESULTS: Pancreaticojejunal anastomotic leakage occurred in 14 patients (16%). In a univariate analysis, pancreatic texture (hard, 3% versus intermediate, 20% versus soft, 23%; p = 0.046), pancreatic duct size (> 3 mm, 8% versus 6.0%) than in those with a normal hemoglobin A1c level. CONCLUSIONS: Pancreatic TIC from dynamic MRI provides reliable information for predicting risk of pancreatic anastomotic leakage after pancreatic head resection. Especially in patients with type I pancreatic TIC, the presence of uncontrolled diabetes is considered a primary risk factor for postoperative pancreatic leakage.