The role of acinar content at pancreatic resection margin in the development of postoperative pancreatic fistula and acute pancreatitis after pancreaticoduodenectomy

Abstract

Purpose: A fatty infiltration of the pancreas has been traditionally regarded as the main histological risk factor for postoperative pancreatic fistula (POPF), whereas the role of the secreting acinar compartment has been poorly investigated. Aim of this study was to evaluate the role of acinar content at pancreatic resection margin in the development of clinically relevant POPF (CR-POPF) and clinically relevant postoperative acute pancreatitis (CR-POAP) after pancreaticoduodenectomy (PD). Method: Data from 388 consecutive patients who underwent PD (2018-2019) were analyzed. Pancreatic section margins were histologically assessed for acinar, fibrosis and fat content. Acinar content was categorized using median and third quartile as cut-offs. Univariate and multivariable analysis of possible predictors of CR-POPF and CR-POAP were performed. Results: Acinar content was <60% in 166 patients (42.8%), ≥60% and ≤80% in 156 patients (40.2%) and >80% in 66 patients (17.0%). The rate of CR-POPF and CR-POAP was significantly higher in patients with acinar content >80% (39.4% and 33.3%, respectively) as well as in those with acinar content ≥60% and ≤80% (36.5% and 35.3%, respectively), compared to patients with acinar content <60% (10.2% and 5.4%, respectively) (P < .001). Acinar content was identified as an independent predictor of CR-POPF [≥60% and ≤80%, odds ratio (OR) 2.51, P = .008; >80%, OR 2.93, P = .010] and CR-POAP (≥60% and ≤80%, OR 9.42, P< .001; >80%, OR 10.16, P < .001). Conclusion: An acinar content at pancreatic resection margin ≥60% is associated to an increased risk of CR-POPF and CR-POAP. Fat content was associated neither with CR-POPF nor with CR-POAP.