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Di Martino, MAuthor

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June 15, 2022
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Development of a prediction model of pancreatic fistula after duodenopancreatectomy and soft pancreas by assessing the preoperative image

Publicated to:LANGENBECKS ARCHIVES OF SURGERY. 407 (6): 2363-2372 - 2022-01-01 407(6), DOI: 10.1007/s00423-022-02564-y

Authors: Maqueda Gonzalez, Rocio; Di Martino, Marcello; Galan Gonzalez, Itxaso; Rodriguez Carnero, Pablo; Martin-Perez, Elena;

Affiliations

AORN Cardarelli, Hepatobiliary & Liver Transplant Surg Dept, Naples, Italy - Author
Autonoma Madrid Univ UAM, La Princesa Hosp, Hlth Res Inst Princesa IIS IP, Gen Surg Dept, Calle Diego Leon 62, Madrid 28006, Spain - Author
Infanta Leonor Hosp, Radiol Dept, Av Gran Via Este 80, Madrid 28031, Spain - Author
La Princesa Hosp, Radiol Dept, Calle Diego Leon 62, Madrid 28006, Spain - Author

Abstract

Background Pancreatic consistency is one of the most widely accepted risk factors of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatectoduodenectomy (PD). The present study aims to identify preoperative characteristics from the preoperative computed tomography (CT) associated with an increased risk. Methods Retrospective observational cohort study of patients who underwent PD surgery (January 2010-2019) were enrolled. All patients with available preoperative imaging were included; 103 met the inclusion criteria. Several parameters were measured on preoperative abdominal CT: retrorenal adipose tissue; abdominal perimeter; total adipose tissue, visceral and subcutaneous; skeletal muscle mass; main pancreatic duct (MPD) diameter; pancreatic thickness; remnant pancreatic volume; pancreatic attenuation (pancreas-to-spleen ratio). Primary endpoints were the association of radiological variables with soft pancreatic consistency and POPF development. All variables possibly associated with POPF and soft pancreas were subsequently included into a multivariable logistic regression model. Results Soft pancreas consistency was found in 43 patients (41.7%) and CR-POPF was higher (51.2% vs. 18%, p < 0.001). Multivariable analysis identified MPD <= 3 mm (OR = 7.2, 95%CI 2.3-23, p = 0.001), a remnant pancreatic volume >= 20 cm(3) (OR = 6.4, 95%CI 2-21, p = 0.041), pancreas-to-spleen < 0.8 (OR = 3.2, 95%CI 1.2-8.4, p = 0.039), and retrorenal adipose tissue >= 12 cm(3) (OR = 5.3, 95%CI 1.8-15.7, p = 0.013). Multivariable analysis showed MPD <= 3 mm (OR = 8.25, 95%CI 2.2-30.8, p = 0.002) and total adipose tissue >= 190 cm(3) (OR = 3.2, 95%CI 1.1-9.1, p = 0.0027) were independent predictors of CR-POPF. Conclusion The preoperative assessment of MPD, remnant pancreatic volume, pancreas-to-spleen ratio, total adipose tissue, and retrorenal adipose tissue are associated with soft pancreas texture and the risk of CR-POPF.

Keywords

anastomotic leakcomputed tomographypancreatic fistulapancreatoduodenectomyAnastomotic failureAnastomotic leakComplicationsComputed tomographyComputed-tomographyCtInternational study-groupPancreatic fistulaPancreaticoduodenectomyPancreatoduodenectomyRiskScoring systemSoft pancreasSurgeonTexture

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal LANGENBECKS ARCHIVES OF SURGERY due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Surgery.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations from Scopus Elsevier, it yields a value for the Field-Weighted Citation Impact from the Scopus agency: 2.17, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 3.48 (source consulted: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-02, the following number of citations:

  • WoS: 1
  • Scopus: 5

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-08-02:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 16.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 19 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 6.55.
  • The number of mentions on the social network X (formerly Twitter): 10 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Italy.