Use of routine CT-SCANS to detect severe postoperative complications after pancreato-duodenectomy

Summary Background To evaluate the performance of CT-scans performed one week after pancreato-duodenectomy (PD) to detect severe postoperative complications requiring an invasive treatment. Patients and methods This monocentric retrospective study was conducted on data collected between 2005 and 2013. Patients undergoing PD underwent CT-scan with IV contrast at the end of the first postoperative week. The results of the CT-scans were analyzed to evaluate the usefulness of this procedure. The main assessment criterion was the occurrence of type-III complication (or greater) according to the Dindo-Clavien classification. Results In total, 138 patients were included. The mortality rate was 2.2%. The postoperative complication rate was 57.2%. The pancreatic fistula rate was 19.6%; 46 patients (33.3%) presented with a severe complication. A total of 138 CT-scans were analyzed: 44 (31.8%) were abnormal, 94 (68.2%) were normal. Among patients with abnormal CT-scans, 17 (39%) presented with a severe complication requiring an invasive treatment. Among the 94 patients with normal CT-scans, 14 patients (15%) presented a severe postoperative complication. Evaluation of the performance of the CT-scans at the end of the first postoperative week found a sensitivity of 55%, a specificity of 75%, a positive predictive value of 39%, and a negative predictive value of 85%. Conclusion Systematic CT-scans performed at the end of the first postoperative week do not effectively detect severe complications after PD and do not help to prevent them.