Abstract
PurposePostoperative pancreatic fistula (POPF) with reported incidence rates up to 45% contributes substantially to overall morbidity. In this study, we conducted a retrospective evaluation of POPF along with its potential perioperative clinical risk factors and its effect on tumor recurrence.MethodsClinical data on patients who had received pancreatoduodenectomy (PD), distal pancreatectomy (DP), or duodenum-preserving pancreatic head resection (DPPHR) were prospectively collected between 2007 and 2016. A Picrosirius red staining score was developed to enable morphological classification of the resection margin of the pancreatic stump. The primary end point was the development of major complications. The secondary end points were overall and recurrence-free survival.Results340 patients underwent pancreatic resection including 222 (65.3%) PD, 87 (25.6%) DP, and 31 (9.1%) DPPHR. Postoperative major complications were observed in 74 patients (21.8%). In multivariable logistic regression analysis, POPF correlated with body mass index (BMI) (p = 0.025), prolonged stay in hospital (p<0.001), high Picrosirius red staining score (p = 0.049), and elevated postoperative levels of amylase or lipase in drain fluid (p≤0.001). Multivariable Cox regression analysis identified UICC stage (p<0.001), tumor differentiation (p<0.001), depth of invasion (p = 0.001), nodal invasion (p = 0.001), and the incidence of POPF grades B and C (p = 0.006) as independent prognostic markers of recurrence-free survival.ConclusionBesides the known clinicopathological risk factors BMI and amylase in the drain fluid, the incidence of POPF correlates with high Picrosirius red staining score in the resection margins of the pancreatic stumps of curatively resected pancreatic ductal adenocarcinoma (PDAC). Furthermore, clinically relevant POPF seems to be a prognostic factor for tumor recurrence in PDAC.
Highlights
Pancreatoduodenectomy (PD) is the preferred therapeutic method for treating benign and malignant diseases of the pancreatic head and its periampullary region
Besides the known clinicopathological risk factors body mass index (BMI) and amylase in the drain fluid, the incidence of Postoperative pancreatic fistula (POPF) correlates with high Picrosirius red staining score in the resection margins of the pancreatic stumps of curatively resected pancreatic ductal adenocarcinoma (PDAC)
Clinically relevant POPF seems to be a prognostic factor for tumor recurrence in PDAC
Summary
Pancreatoduodenectomy (PD) is the preferred therapeutic method for treating benign and malignant diseases of the pancreatic head and its periampullary region. Postoperative pancreatic fistula (POPF) with reported incidence rates between 3% and 45% substantially contributes to overall morbidity with increased hospital stay, costs and reintervention rates and in case of abscess formation, sepsis, and hemorrhage to mortality as well [4,5]. Clinically relevant POPF with prolonged hospital stay may delay adjuvant treatment and affect oncologic outcomes in malignant pancreatic diseases [6]. In 2017, clinically relevant POPF was redefined as drainage fluid of any measurable volume with amylase level more than three times that of physiological serum amylase activity, associated with a clinically relevant condition related directly to the POPF, which can originate from pancreaticoenteric or pancreaticogastric anastomosis after head resection or drainage procedures and of pancreatic remnant after distal pancreatectomy or enucleation [8]
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