Predictive value of ultrasonic elastometry in the occurrence of postoperative pancreatic fistula after pancreatic resection
The aim of the research.To evaluate the effectiveness of endoscopic ultrasonographic (EUS) elastometry in preoperative prediction of the risk of postoperative pancreatic fistulas (PPF) in patients undergoing resection interventions on the pancreas (P). Material and methods. A two-center prospective controlled study was conducted. The study included 30 patients, all of whom were operated on (distal resection of the pancreas or pancreatoduodenal resection). EUS elastometry was performed with the calculation of the coefficient of deformation (CD) equal to the ratio of the stiffness of the parapancreatic tissue (reference area) to the stiffness of the pancreatic parenchyma in the area of the proposed resection. Patients were divided into two groups: 1) patients whose postoperative period proceeded without the development of PPF, and 2) patients with the presence of clinically significant PPF. To assess the significance of differences, the Mann-Whitney U test or the Student's test were used. The y2 criterion was used when comparing groups on a qualitative basis. ROC analysis was performed to calculate optimal cutoff points. Static processing of results using Statistica 10.0. Results. Clinically significant PPF were observed in 7 (23.4 %) cases (type B - 6, type C - 1). The difference in the mean deformation coefficient (CD) between the groups of patients without and with the presence of pancreatic fistulas was statistically significant (36.7±4.1 versus 15.8±2.3, p<0.01, respectively). When conducting ROC analysis, the optimal cut-off point of elastometric СD in predicting the risk of developing PPF was determined, which was 23.3. With a value of D < 23.3, the risk of developing PPF is assessed as high, with a СD > 23.3, the risk of developing PPF is low. The sensitivity, specificity and overall accuracy of the developed model are 85.7 %, 82.6 % and 83.3 %, respectively. Conclusion. Ultrasonographic elastometry is an applicable technique in predicting the risk of developing PPF, which has a fairly high accuracy.