Postoperative Visceral Tissue Edema Assessed by Computed Tomography Is a Predictor for Severe Complications After Pancreaticoduodenectomy

In pancreatoduodenectomy (PD), the adverse impact of tissue edema owing to intraoperative fluid overload remains unclear. This study aims to evaluate how visceral tissue edema due to fluid overload affects severe postoperative complications after PD. It aims to clarify the usefulness of assessment by computed tomography (CT) of postoperative tissue edema. We classified 200 patients who underwent PD as either liberal fluid management (LFM) group (n = 100) or goal-directed fluid therapy (GDFT) group (n = 100), based on intraoperative fluid management. We assessed postoperative tissue edema by cross section of the body trunk area using pre- and postoperative CT. Severe complication (Clavien-Dindo more than grade III) rate was significantly higher in LFM group than GDFT group (37 vs. 17%, P = 0.001). Independent risk factors of severe complications after PD included diameter of main pancreatic duct <= 3 mm at the cut surface (P = 0.041; OR 2.274; 95% CI 1.034-5.001), LFM (P = 0.005; OR 2.720; 95% CI 1.355-5.462), and increased rate of body trunk area >= 20% (P < 0.001; OR 3.448; 95% CI 1.723-5.462). In subgroup analysis of patients with no transfusion, LFM and increased rate of body trunk area >= 20% were independent risk factors of severe postoperative complications. Visceral tissue edema evaluation is a valuable method to predict severe complications after PD.