Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Medical Faculty of University Zurich, Zurich, Switzerland.
Langenbecks Arch Surg. 2021 May;406(3):729-734. doi: 10.1007/s00423-020-02071-y. Epub 2021 Jan 8.
The relevance of pancreatic texture for pancreatic fistula (POPF) formation after distal pancreatectomy (DP) remains ill defined. Recent POPF definition adjustments and common subjective pancreatic texture assessment are further drawbacks in the investigation of pancreatic texture as a factor for POPF development after DP.
The predictive value of pancreatic texture by histologic assessment was investigated for POPF formation after DP, respecting the updated 2016 fistula definition. Histologic evaluation at the resection margin included amount of steatosis, degree of fibrosis, and pancreatic duct size.
A total of 102 patients who underwent DP were included. Thirty-six patients developed POPF. There was no difference in histologic variables in patients with and without POPF. In the univariate analysis, none of the three histologic features showed significant correlation with POPF formation. The ROC (receiver operating characteristic) curve demonstrated poor utility for the grade of steatosis 0.481 ± 0.058 (p = 0.75) and grade of fibrosis 0.466 ± 0.058 (p = 0.57) as predictive factors for POPF formation.
Results indicate that pancreatic texture does not predict POPF formation following DP. This is particularly relevant in the context of the increasing use of robotic and laparoscopic approaches for DPs with limited clinical pancreatic texture assessment by palpation.
远端胰腺切除术（DP）后胰瘘（POPF）形成与胰腺质地的相关性仍未明确。最近对 POPF 定义的调整和常用的主观胰腺质地评估是研究 DP 后胰腺质地作为 POPF 发展因素的进一步缺陷。
根据更新的 2016 年瘘管定义，研究了组织学评估的胰腺质地对 DP 后 POPF 形成的预测价值。在切缘的组织学评估中包括脂肪变性程度、纤维化程度和胰管大小。
共纳入 102 例行 DP 的患者。36 例患者发生 POPF。有和无 POPF 的患者在组织学变量方面没有差异。在单因素分析中，这三个组织学特征均与 POPF 形成无显著相关性。ROC（接受者操作特征）曲线表明，脂肪变性程度 0.481±0.058（p=0.75）和纤维化程度 0.466±0.058（p=0.57）作为预测因素对 POPF 形成的效用较差。
结果表明，胰腺质地不能预测 DP 后 POPF 的形成。在机器人和腹腔镜方法广泛应用的背景下，由于对 DP 的临床胰腺质地评估有限，这一点尤为重要。
