The Correlation Between the Stenosis of Celiac Axis and Superior Mesenteric Artery and Complications After Pancreatoduodenectomy

OBJECTIVES: To explore the correlation between the stenosis of the celiac axis (CA) and the superior mesenteric artery (SMA) and complications after pancreatoduodenectomy (PD). MATERIALS AND METHODS: This retrospective study analyzed patients undergoing PD at the Pancreas Center of our hospital between January 2021 and December 2023. The stenosis of CA and SMA was measured using preoperative arterial phase imaging of contrast-enhanced multidetector computed tomography (MDCT). CA and SMA stenosis were defined as a stenosis rate ≥50%. The correlation between celiac axis stenosis (CAS), SMA stenosis, and postoperative complications was systematically evaluated. Univariate and multivariate logistic regression analyses were performed to identify risk factors for major complications after PD. RESULTS: A total of 900 patients were enrolled in this study. CAS was identified in 70 (7.8%) patients, and SMA stenosis was identified in 43 (4.8%) patients. CAS was significantly associated with postoperative pancreatic fistula (POPF) ( P =0.044), postpancreatectomy hemorrhage (PPH) ( P =0.003), delayed gastric emptying (DGE) ( P =0.013) and biliary fistula (BF) ( P =0.014). Multivariate analysis revealed that CAS was an independent risk factor for POPF (OR: 2.632, 95% CI: 1.409-4.917, P =0.002) and PPH (OR: 3.745, 95% CI: 1.699-8.257, P =0.001). No significant correlation was found between SMA stenosis and complications after PD. CONCLUSIONS: CAS identified by preoperative contrast-enhanced MDCT was associated with the risk of complications after PD. Radiologists and surgeons should evaluate the condition of CAS in patients before PD.