Abstract
The aim of this retrospective study was thus to evaluate postoperative morphological changes in the remnant pancreas after pancreaticoduodenectomy (PD) associated with postoperative pancreatic fistula (POPF). Fifty-one patients subjected to PD were enrolled in the study and allocated into 2 groups according to the presence (n = 16) or absence of POPF (n = 35). A morphological evaluation of the pancreas was conducted for up to a 20 months follow-up on CT scans and compared between groups. No significant differences were observed in morphology between the groups at the different preoperative and PO intervals, regardless of the clinical relevance of the POPF or POPF grade. However, in the overall patient analysis we observed a significant reduction of the entire pancreas over time. In fact, thickness decreased 0.4 mm/month, length 1.2 mm/month and volume 1.17 cm3/month over the PO. The impact of age, POPF, type of anastomosis, surgical technique and PO follow-up (time) was evaluated in a multivariate analysis using the general linear model, but only PO follow-up had a significant influence on the final model (p < 0.001). A significant reduction on pancreatic parenchyma (thickness, length and volume) occurs after PD with no significant differences between patients with or without POPF.
Highlights
Pancreaticoduodenectomy (PD) with or without pylorus preservation has emerged as a standard therapeutic method for treating either malignant or benign diseases of the pancreatic head and/or periampullary region[1]
No studies have revealed significant differences in the rate of complications using different pancreatic anastomosis techniques[9,10], some have observed the frequent impairment of the pancreatic juice outflow due to stenosis of the pancreaticoenterostomy and atrophy of the pancreas associated with pancreatic exocrine insufficiency[9,11,12,13]
According to the above significance threshold, no differences were found in variables between the groups, except in the mean age, which was higher in the postoperative pancreatic fistula (POPF) group (p = 0.032)
Summary
Pancreaticoduodenectomy (PD) with or without pylorus preservation has emerged as a standard therapeutic method for treating either malignant or benign diseases of the pancreatic head and/or periampullary region[1]. Sex (male/female) Age (years) Consistency of the pancreas Soft/Normal Fibrotic Unknow Type of tumour Adenocarcinoma Cholangiocarcinoma Others Type of anastomosis PJ PG None Surgical technique PD PPPD Duration of the intervention (min) Hospital stay (days) ASA I II III Type of surgical approach Open Laparoscopic Conversion Hand-assisted Supplementary enzymes Preoperative diabetes New onset postoperative diabetes Neoadjuvant chemotherapy Adjuvant chemotherapy atrophy may be preoperative factors, such as preexisting obstructive pancreatitis, and postoperative factors such as quantitative diminution of the pancreatic parenchyma as a result of the resection, stenosis of the pancreaticoenterostomy, malnutrition and deregulation of pancreatic neurohormonal stimulator mechanisms Complications such as POPF could have an important effect on the parenchymal atrophy of the remnant pancreas due to chronic inflammation, obstruction or stenosis of the anastomosis[16].
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