Clinically relevant postoperative pancreatic fistula (CR-POPF) can significantly affect the treatment course and outcome in pancreatic cancer patients. Preoperative prediction of CR-POPF can aid surgical decision-making process and lead to better perioperative management of patients. In this retrospective study, we have developed radiomic risk models that use preoperative computed tomography (CT)-based radiomic features in a cohort of 148 patients having undergone pancreaticoduodenectomy.The developed models were compared with risk models using preoperative clinical features and mesh-based volumes of the annotated structures. The model signatures were analysed in detail by visualising feature expression maps and comparing significant features to the standard CR-POPF risk measures. The best average area under receiver operating characteristic curve (AUC) of 0.81 on validation data was achieved by the radiomic signature model retrained using the most important features. The following features showed significant correlation with outcome (p < 0.05)- texture and morphology of healthy pancreatic segment, intensity volume histogram-based feature of pancreatic duct segment and morphology of combined segment; mesh-based volumes of healthy pancreatic segment, segment containing arteries, combined segment and pancreatic duct segment; BMI and sex. The results of the study indicate that preoperative data can be useful for an accurate risk assessment of CR-POPF.

The authors have declared no competing interest.

The research was carried out within the Surgomics project funded by the German Federal Ministry of Health, University Hospital Heidelberg and Uniklinikum Carl Gustav Carus, Dresden. Partners from industry: Karl Storz GmbH and Phellow Seven GmbH.

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Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval for the retrospective analyses of clinical and imaging data was obtained from the Ethics Committee at the Technical University Dresden (BO-EK-263062020). All analyses were carried out in accordance with the relevant guidelines and regulations, in particular the Declaration of Helsinki and its later amendments. The local institutional review board (Ethics Committee at the Technical University Dresden) approved the study protocol (BO-EK-263062020) and waived written patient consent for the retrospective analysis of routinely acquired anonymised clinical data.

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All data produced in the present study are available upon reasonable request to the authors.