Association Between Preoperative Pancreatic Exocrine Function and Pathological Evaluation With Postoperative Pancreatic Fistulas Following Pancreaticoduodenectomy.

Abstract

Postoperative pancreatic fistula (POPF) may cause severe complications. In this study, risk factors for postoperative pancreatic fluid leakage after pancreaticoduodenectomy (PD) were investigated, with a particular focus on preoperative pancreatic exocrine function and pathological evaluations of the resected pancreas. A total of 67 patients underwent the N-benzoyl-L-tyrosyl-para-aminobenzoic acid (BT-PABA) test and PD in our department between June 2003 and March 2018. The endpoint was the development of POPF. Patients' clinical characteristics, preoperative test results, surgery-related parameters, and pathological evaluations of the resected samples were investigated. Preoperative pancreatic exocrine function was evaluated by the BT-PABA test, and the proportion of residual acinar tissue and the fibrosis rate of the resected pancreatic tissue were assessed. 17 (25.4%) patients with Grade B and C POPF were compared with 50 patients without POPF. On univariate analysis, pancreatic carcinoma (p=0.028), BT-PABA test results higher than 66.3% (p=0.030), and main pancreatic duct (MPD) diameter lower than 5.0 mm (p=0.006) were identified as risk factors for postoperative pancreatic fluid leakage. On multivariate analysis, pancreatic carcinoma (p=0.008), BT-PABA test results higher than 66.3% (p=0.036), MPD diameter lower than 5.0mm (p=0.029) were significant risk factors. BT-PABA test results have a moderate correlation with both the proportion of pancreatic acinar tissue (r=0.421, p=0.028) and the pancreatic fibrosis rate (r=-0.443, p=0.021). The preoperative BT-PABA test results higher than 66.3% were an independent risk factor for POPF. This suggests that the development of POPF may be attenuated by diminished exocrine function with poor pancreatic fluid flow and the progression of fibrosis.