Computer tomographic assessment of postoperative peripancreatic
collections after distal pancreatectomy
Received: 6 December 2017 / Accepted: 19 March 2018 / Published online: 27 March 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Peripancreatic collections occur frequently after distal pancreatectomy. However, the sequelae of peripancreatic
collections vary from case to case, and their clinical impact is uncertain. In this study, the correlations between CT findings of
peripancreatic collections and complications after distal pancreatectomy were investigated.
Methods Ninety-six consecutive patients who had undergone distal pancreatectomy between 2010 and 2015 were retrospec-
tively investigated. The extent and heterogeneity of peripancreatic collections and background clinicopathological characteristics
were analyzed. The extent of peripancreatic collections was calculated based on three-dimensional computed tomography
images, and the degree of heterogeneity of peripancreatic collections was assessed based on the standard deviation of their
density on computed tomography.
Results Of 85 patients who underwent postoperative computed tomography imaging, a peripancreatic collection was detected in
77 (91%). Patients with either a large extent or a high degree of heterogeneity of peripancreatic collection had a significantly
higher rate of clinically relevant pancreatic fistula than those without (odds ratio 5.95, 95% confidence interval 2.12–19.72, p =
0.001; odds ratio 8.0, 95% confidence interval 2.87–24.19, p = 0.0001, respectively).
Conclusions A large and heterogeneous peripancreatic collection was significantly associated with postoperative complications,
especially clinically relevant postoperative pancreatic fistula. A small and homogenous peripancreatic collection could be safely
Keywords Peripancreatic collection
Distal pancreatectomy (DP) is a standard operation for various
types of tumors in the body or tail of the pancreas. A postop-
erative pancreatic fistula (POPF) is a major complication after
DP despite continued efforts at its prevention [1, 2]. Although
the character of the drain discharge is one of the most useful
pieces of information [3, 4], such information has sometimes
been missed, because early removal or omission of the drain is
common in daily clinical practice to avoid retrograde infection
[5, 6]. However, some patients have an unfavorable course
even after drain removal. In such cases, we have to evaluate
the severity of POPF based on symptoms, laboratory data, or
imaging studies such as computed tomography (CT).
Although several reports refer to how to predict the develop-
ment of POPF by preoperative CT, there is little evidence
about the relationship between postoperative CT and POPF.
We have been performing routine CT around 1 week after
pancreatic surgery and frequently found a peripancreatic col-
lection (PC) around the pancreatic stump after DP. So far, it is
not clear whether the PC is related to biochemical leakage
(BL) and/or clinically relevant POPF (CR-POPF). In this
study, whether the extent and the heterogeneity of PC were
related with POPF after DP was investigated.
* Toshihiko Masui
Division of Hepatobiliary Pancreatic Surgery and Transplantation,
Department of Surgery, Kyoto University, Syogoinkawaharacho 54,
Sakyo-ku, Kyoto, Japan
Langenbeck's Archives of Surgery (2018) 403:349–357