Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: https://twitter.com/spartelli.
Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: https://twitter.com/valentinandreas.
Surgery. 2021 Oct;170(4):1215-1222. doi: 10.1016/j.surg.2021.03.047. Epub 2021 Apr 28.
A fatty infiltration of the pancreas has been traditionally regarded as the main histological risk factor for postoperative pancreatic fistula, whereas the role of the secreting acinar compartment has been poorly investigated. The aim of this study was to evaluate the role of acinar content at the pancreatic resection margin in the development of clinically relevant postoperative pancreatic fistula and clinically relevant postoperative acute pancreatitis after pancreaticoduodenectomy.
Data from 388 consecutive patients who underwent pancreaticoduodenectomy (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 clinically relevant postoperative pancreatic fistula and clinically relevant postoperative acute pancreatitis were performed.
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 clinically relevant postoperative pancreatic fistula and clinically relevant postoperative acute pancreatitis 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 with patients with acinar content <60% (10.2% and 5.4%, respectively) (P < .001). Acinar content was identified as an independent predictor of clinically relevant postoperative pancreatic fistula (≥60% and ≤80%, odds ratio 2.51, P = .008; >80%, odds ratio 2.93, P = .010) and clinically relevant postoperative acute pancreatitis (≥60% and ≤80%, odds ratio 9.42, P < .001; >80%, odds ratio 10.16, P < .001).
An acinar content at the pancreatic resection margin ≥60% is associated to an increased risk of clinically relevant postoperative pancreatic fistula and clinically relevant postoperative acute pancreatitis. Fat content was associated neither with clinically relevant postoperative pancreatic fistula nor with clinically relevant postoperative acute pancreatitis.
胰腺脂肪浸润传统上被认为是术后胰瘘的主要组织学危险因素，而分泌腺泡的作用则研究甚少。本研究旨在评估胰腺切除缘腺泡含量在胰十二指肠切除术后发生临床相关胰瘘和临床相关术后急性胰腺炎中的作用。
分析了 2018-2019 年连续 388 例接受胰十二指肠切除术的患者的数据。对胰腺切面的腺泡、纤维化和脂肪含量进行组织学评估。使用中位数和第三四分位数作为截点对腺泡含量进行分类。对可能预测临床相关术后胰瘘和临床相关术后急性胰腺炎的预测因子进行单变量和多变量分析。
166 例患者（42.8%）的腺泡含量<60%，156 例患者（40.2%）的腺泡含量≥60%且≤80%，66 例患者（17.0%）的腺泡含量>80%。腺泡含量>80%的患者（分别为 39.4%和 33.3%）和腺泡含量≥60%且≤80%的患者（分别为 36.5%和 35.3%）的临床相关术后胰瘘和临床相关术后急性胰腺炎发生率明显高于腺泡含量<60%的患者（分别为 10.2%和 5.4%）（P<.001）。腺泡含量是临床相关术后胰瘘（≥60%且≤80%，比值比 2.51，P=.008；>80%，比值比 2.93，P=.010）和临床相关术后急性胰腺炎（≥60%且≤80%，比值比 9.42，P<.001；>80%，比值比 10.16，P<.001）的独立预测因子。
胰腺切除缘的腺泡含量≥60%与临床相关术后胰瘘和临床相关术后急性胰腺炎的风险增加相关。脂肪含量与临床相关术后胰瘘和临床相关术后急性胰腺炎均无关。
