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It is not possible to perform preoperative risk stratification for all patients. This study aimed to evaluate the usefulness of the measurement of portal vein (PV) distance as a predictive indicator of pancreatic fistula development after pancreatoduodenectomy and compare it with the usefulness of other indicators such as body mass index (BMI), and abdominal fat area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patient characteristics, preoperative laboratory data, radiographic findings, and their association with pancreatic fistula development after pancreatoduodenectomy were analyzed for 157 patients who underwent resection during 2011\u20132017. Clinically relevant postoperative pancreatic fistulas (CR\u2010POPF) were defined as Grade B or C fistulas based on the International Study Group of Pancreatic Surgery (ISGPS) 2016 consensus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CR\u2010POPF developed in 38 patients (24.2%). Multivariate logistic regression indicated that PV distance and BMI were potential candidates for predictive models for pancreatic fistula development, and small pancreatic duct diameter, diabetes mellitus development, and pathology of non\u2010pancreatic cancers were independent factors for CR\u2010POPF. When comparing the two risk models (PV distance\u2010 and BMI\u2010based models), the PV distance\u2010derived risk model was compatible to the BMI\u2010based stratification models (area under the curve 0.831 vs. 0.830).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PV distance was confirmed to be a useful risk predictor for CR\u2010POPF. This research highlighted the efficacy of abdominal thickness measurement, which is simple and easily applicable in the clinical setting.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-021-06076-6","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T19:03:01Z","timestamp":1617217381000},"page":"2200-2209","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical Impact of Portal Vein Distance on Computed Tomography for Postoperative Pancreatic Fistula after Pancreatoduodenectomy"],"prefix":"10.1002","volume":"45","author":[{"given":"Yutaka","family":"Endo","sequence":"first","affiliation":[{"name":"Department of Surgery Keio University School of Medicine Shinanomachi 35 160\u20108582 Shinjuku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Kitago","sequence":"additional","affiliation":[{"name":"Department of Surgery Keio 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