DOI QR코드

DOI QR Code

Normal Postoperative Computed Tomography Findings after a Variety of Pancreatic Surgeries

  • Seo, Ji Won (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Hwang, Ho Kyoung (Department of Surgery, Yonsei University College of Medicine) ;
  • Lee, Minwook (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Ki Whang (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kang, Chang Moo (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Myeong-Jin (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Chung, Yong Eun (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine)
  • Received : 2016.05.09
  • Accepted : 2016.09.14
  • Published : 2017.04.01

Abstract

Pancreatic surgery remains the only curative treatment for pancreatic neoplasms, and plays an important role in the management of medically intractable diseases. Since the original Whipple operation in the 20th century, surgical techniques have advanced, resulting in decreased postoperative complications and better clinical outcomes. Normal postoperative imaging findings vary greatly depending on the surgical technique used. Radiologists are required to be familiar with the normal postoperative imaging findings, in order to distinguish from postoperative complications or tumor recurrence. In this study, we briefly review a variety of surgical techniques for the pancreas, and present the normal postoperative computed tomography findings.

Keywords

Acknowledgement

Supported by : Yonsei University

References

  1. Ozawa F, Friess H, Kunzli B, Shrikhande SV, Otani T, Makuuchi M, et al. Treatment of pancreatic cancer: the role of surgery. Dig Dis 2001;19:47-56 https://doi.org/10.1159/000050653
  2. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery 2003;133:521-527 https://doi.org/10.1067/msy.2003.146
  3. Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisited. J Gastrointest Surg 2006;10:804-812 https://doi.org/10.1016/j.gassur.2005.11.012
  4. Ho CK, Kleeff J, Friess H, Buchler MW. Complications of pancreatic surgery. HPB (Oxford) 2005;7:99-108 https://doi.org/10.1080/13651820510028936
  5. Casadei R, Ricci C, Antonacci N, Minni F. Indications and technique of central pancreatectomy. In: Siquini W, ed. Surgical treatment of pancreatic disease. Milan: Springer Milan, 2009:329-336
  6. Kim MJ, Choi JY, Chung YE. Evaluation of biliary malignancies using multidetector-row computed tomography. J Comput Assist Tomogr 2010;34:496-505 https://doi.org/10.1097/RCT.0b013e3181d34532
  7. Bhosale P, Fleming J, Balachandran A, Charnsangavej C, Tamm EP. Complications of Whipple surgery: imaging analysis. Abdom Imaging 2013;38:273-284 https://doi.org/10.1007/s00261-012-9912-4
  8. Diener MK, Fitzmaurice C, Schwarzer G, Seiler CM, Huttner FJ, Antes G, et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2014;(11):CD006053
  9. Yamauchi FI, Ortega CD, Blasbalg R, Rocha MS, Jukemura J, Cerri GG. Multidetector CT evaluation of the postoperative pancreas. Radiographics 2012;32:743-764 https://doi.org/10.1148/rg.323105121
  10. Poon RT, Lo SH, Fong D, Fan ST, Wong J. Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy. Am J Surg 2002;183:42-52 https://doi.org/10.1016/S0002-9610(01)00829-7
  11. Kennedy EP, Yeo CJ. Dunking pancreaticojejunostomy versus duct-to-mucosa anastomosis. J Hepatobiliary Pancreat Sci 2011;18:769-774 https://doi.org/10.1007/s00534-011-0429-y
  12. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8-13 https://doi.org/10.1016/j.surg.2005.05.001
  13. El Nakeeb A, El Hemaly M, Askr W, Abd Ellatif M, Hamed H, Elghawalby A, et al. Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study. Int J Surg 2015;16(Pt A):1-6 https://doi.org/10.1016/j.ijsu.2015.02.002
  14. Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, et al. Duct-to-mucosa versus end-toside pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery 2003;134:766-771 https://doi.org/10.1016/S0039-6060(03)00345-3
  15. Raman SP, Horton KM, Cameron JL, Fishman EK. CT after pancreaticoduodenectomy: spectrum of normal findings and complications. AJR Am J Roentgenol 2013;201:2-13 https://doi.org/10.2214/AJR.12.9647
  16. Ben-Ishay O, Assi Z, Kluger Y. Pancreaticojejunostomy: images of an invagination technique. JOP 2010;11:642-643
  17. Lepanto L, Gianfelice D, Dery R, Dagenais M, Lapointe R, Roy A. Postoperative changes, complications, and recurrent disease after Whipple's operation: CT features. AJR Am J Roentgenol 1994;163:841-846 https://doi.org/10.2214/ajr.163.4.7916530
  18. Zhu F, Wang M, Wang X, Tian R, Shi C, Xu M, et al. Modified technique of pancreaticogastrostomy for soft pancreas with two continuous hemstitch sutures: a single-center prospective study. J Gastrointest Surg 2013;17:1306-1311 https://doi.org/10.1007/s11605-013-2183-8
  19. Xiong JJ, Tan CL, Szatmary P, Huang W, Ke NW, Hu WM, et al. Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Br J Surg 2014;101:1196-1208 https://doi.org/10.1002/bjs.9553
  20. Tamm EP, Jones B, Yeo CJ, Maher MM, Cameron JL. Pancreaticogastrostomy and the Whipple procedure: radiographic appearance and complications. Radiology 1995;196:251-255 https://doi.org/10.1148/radiology.196.1.7784577
  21. Parikh PY, Lillemoe KD. Surgical management of pancreatic cancer--distal pancreatectomy. Semin Oncol 2015;42:110-122 https://doi.org/10.1053/j.seminoncol.2014.12.010
  22. Trottman P, Swett K, Shen P, Sirintrapun J. Comparison of standard distal pancreatectomy and splenectomy with radical antegrade modular pancreatosplenectomy. Am Surg 2014;80:295-300
  23. Strasberg SM, Fields R. Left-sided pancreatic cancer: distal pancreatectomy and its variants: radical antegrade modular pancreatosplenectomy and distal pancreatectomy with celiac axis resection. Cancer J 2012;18:562-570 https://doi.org/10.1097/PPO.0b013e31827596c5
  24. Warshaw AL. Distal pancreatectomy with preservation of the spleen. J Hepatobiliary Pancreat Sci 2010;17:808-812 https://doi.org/10.1007/s00534-009-0226-z
  25. Ferrone CR, Konstantinidis IT, Sahani DV, Wargo JA, Fernandez-del Castillo C, Warshaw AL. Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg 2011;253:1136-1139 https://doi.org/10.1097/SLA.0b013e318212c1e2
  26. Crippa S, Tamburrino D, Partelli S, Salvia R, Germenia S, Bassi C, et al. Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery 2011;149:79-86 https://doi.org/10.1016/j.surg.2010.04.007
  27. Santoro R. Total pancreatectomy: indications, technique, and postoperative problems. In: Siquini W, ed. Surgical treatment of pancreatic disease. Milan: Springer Milan, 2009:337-348
  28. Gavazzi F, Zerbi A, Di Carlo V. Indications for surgery and surgical procedures for chronic pancreatitis. In: Siquini W, ed. Surgical treatment of pancreatic disease. Milan: Springer Milan, 2009:127-137
  29. Aghdassi AA, Mayerle J, Kraft M, Sielenkamper AW, Heidecke CD, Lerch MM. Pancreatic pseudocysts--when and how to treat? HPB (Oxford) 2006;8:432-441 https://doi.org/10.1080/13651820600748012
  30. Maithel SK, Fong Y. Technical aspects of performing transduodenal ampullectomy. J Gastrointest Surg 2008;12:1582-1585 https://doi.org/10.1007/s11605-008-0474-2

Cited by

  1. Imaging of post-operative pancreas and complications after pancreatic adenocarcinoma resection vol.43, pp.2, 2017, https://doi.org/10.1007/s00261-017-1378-y
  2. Measurement of Pancreatic Fat Fraction by CT Histogram Analysis to Predict Pancreatic Fistula after Pancreaticoduodenectomy vol.20, pp.4, 2017, https://doi.org/10.3348/kjr.2018.0557