Role of fat and fibrosis in post-operative pancreatic fistula

Abstract

Background: To study the influence of pancreatic fat and fibrosis on post-operative pancreatic fistula. To determine the factors associated with fat and fibrosis of the pancreas. Methods: Retrospective analysis of prospectively maintained database was performed in the Department of G.I.Surgery,NIMS, India .All PD specimens were assessed for the amount of fat and fibrosis in the neck of pancreas by a single pathologist who is blinded for all clinical details. Histological sections were graded (0–4) for intralobular fat, total fat and fibrosis. Univariate and a sequential binary logistic regression analysis was performed. Amount of fat and fibrosis was correlated with the texture of pancreas identified during surgery. Statistical analysis was performed using SPSS 17. Results: Pancreatic fistula occurred in 13 patients (Grade A-6, B-4, C-3).Significant risk factors for pancreatic fistula on univariate analysis are serum bilirubin, soft pancreas, fatty pancreas grade >1, fibrosis, PD <3 mm (Table 1).In a multivariate model only soft pancreas was found to be a significant factor for pancreatic fistula (OR 5.864, CI 1.11–30.95, p = 0.037). Pancreatic fistula patients had more Intralobular fat (p = 0.001), total fat (p = 0.03) and less fibrosis (p = 0.017) of the pancreas. Soft pancreas had more fat (p = 0.08) and less fibrosis (p = 0.09) .Fatty infiltration was more common in elderly (p = 0.017) and obese individuals. Fibrosis was more common in smokers (p = 0.09) and chronic pancreatitis (p = 0.01). Conclusion: Soft pancreas is an independent risk factor for pancreatic fistula while fat and fibrosis were not. Soft pancreas had more fat and less fibrosis.