Rykina-Tameeva Nadya, Nahm Christopher B, Mehta Shreya, Gill Anthony J, Samra Jaswinder S, Mittal Anubhav
Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia.
Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia; Northern Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, NSW, Australia.
HPB (Oxford). 2020 Nov;22(11):1631-1636. doi: 10.1016/j.hpb.2020.03.007. Epub 2020 Apr 2.
Postoperative pancreatic fistula (POPF) remains a prominent complication following pancreatic cancer resections. The primary aim of this study was to evaluate the histological changes that occur in the pancreas due to neoadjuvant therapy (NAT) by comparing the acinar, collagen and fat scores in resected PDAC specimens of patients who did and did not receive NAT. Secondary aims included (1) the difference in rates of POPF in PDAC patients who received NAT versus upfront resection; and (2) the association between acinar/collagen/fat scores and the development of POPF.
Consecutive patients who underwent pancreaticoduodenectomy for PDAC, with and without NAT were included for analysis. Acinar, collagen and fat scores were determined from histology slides of the pancreatic resection margin.
One hundred and thirty-four patients were included. There was a significant decrease in the median acinar score (48 vs 23, p = 0.003) and increase in the collagen score (28 vs 50, p = 0.011) for patients who received NAT and a significant correlation with the number of cycles of NAT. This study found no statistical difference between NAT and the development of POPF.
The use of NAT in the treatment of PDAC changes the composition of the pancreas.
术后胰瘘（POPF）仍是胰腺癌切除术后的一个突出并发症。本研究的主要目的是通过比较接受和未接受新辅助治疗（NAT）的患者切除的胰腺导管腺癌（PDAC）标本中的腺泡、胶原蛋白和脂肪评分，评估因新辅助治疗而在胰腺中发生的组织学变化。次要目的包括：（1）接受NAT的PDAC患者与直接手术切除患者的POPF发生率差异；（2）腺泡/胶原蛋白/脂肪评分与POPF发生之间的关联。
纳入连续接受PDAC胰十二指肠切除术的患者，无论是否接受NAT，均纳入分析。从胰腺切除边缘的组织学切片中确定腺泡、胶原蛋白和脂肪评分。
共纳入134例患者。接受NAT的患者腺泡评分中位数显著降低（48对23，p = 0.003），胶原蛋白评分升高（28对50，p = 0.011），且与NAT的疗程数显著相关。本研究发现NAT与POPF的发生之间无统计学差异。
在PDAC治疗中使用NAT会改变胰腺的组成。
