Magnetic resonance imaging relevance in diagnosis and prognosis of early postoperative period following pancreatic cancer surgical treatment

Purpose of the study. Improvement of the prognostic outcomes for the pancreatic fistula development in surgical treatment for pancreatic cancer by implementation of new diagnostic algorithms for magnetic resonance imaging (MRI) assessment of supposed pancreatic stump.

Materials and methods. We performed a retrospective analysis of MRI results of 1136 patients from the medical data base of National Medical Research Centre for Oncology for 2009–2020. An original scanning technique, trans- and cross-pancreatic imaging and MR spectroscopy of the pancreas in patients with pancreatic cancer, was developed and applied. Preoperative examinations were compared retrospectively: a standard MRI protocol without anatomical orientation of the series; MRI protocol using the developed technology.

Results. 717 patients were diagnosed with advanced pancreatic cancer. Lymph nodes were affected in 302 patients among 419 patients with radical surgeries. All cases were confirmed morphologically. In the group of 419 patients with pancreatic resections, based on the analysis of morphological and clinical data and preoperative MRI data, we developed an original preoperative scale for assessing the risk of pancreatic fistula development and compared its accuracy with other intraoperative scales, FRS and modified FRS. Lactate and lipid complex were selected from a wide range of metabolites. The surgical protocols and results of histological examination of the surgical material were used to prove the accuracy of the study. The overall accuracy of the technique in predicting fistula development was 97.5 %. New visual predictors («domino» and «white on white» symptoms) based on MRI data were used to improve the scale accuracy.

Conclusion. The developed method of using a modified scale for risk assessment of pancreatic fistula development allows predicting the onset of early postoperative complications already at the preoperative stage. When comparing the calculated risks of pancreatic fistula according to the developed scale with the results by the known scales (FRS and modified FRS), statistical analysis showed a significant difference for the better when compared with FRS (p = 0.0477), and a tendency when compared with modified FRS (p = 0.0544).

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