Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
PLoS One. 2021 Jun 4;16(6):e0252727. doi: 10.1371/journal.pone.0252727. eCollection 2021.
Postoperative pancreatic fistula (POPF) with reported incidence rates up to 45% contributes substantially to overall morbidity. In this study, we conducted a retrospective evaluation of POPF along with its potential perioperative clinical risk factors and its effect on tumor recurrence.
Clinical data on patients who had received pancreatoduodenectomy (PD), distal pancreatectomy (DP), or duodenum-preserving pancreatic head resection (DPPHR) were prospectively collected between 2007 and 2016. A Picrosirius red staining score was developed to enable morphological classification of the resection margin of the pancreatic stump. The primary end point was the development of major complications. The secondary end points were overall and recurrence-free survival.
340 patients underwent pancreatic resection including 222 (65.3%) PD, 87 (25.6%) DP, and 31 (9.1%) DPPHR. Postoperative major complications were observed in 74 patients (21.8%). In multivariable logistic regression analysis, POPF correlated with body mass index (BMI) (p = 0.025), prolonged stay in hospital (p<0.001), high Picrosirius red staining score (p = 0.049), and elevated postoperative levels of amylase or lipase in drain fluid (p≤0.001). Multivariable Cox regression analysis identified UICC stage (p<0.001), tumor differentiation (p<0.001), depth of invasion (p = 0.001), nodal invasion (p = 0.001), and the incidence of POPF grades B and C (p = 0.006) as independent prognostic markers of recurrence-free survival.
Besides the known clinicopathological risk factors BMI and amylase in the drain fluid, the incidence of POPF correlates with high Picrosirius red staining score in the resection margins of the pancreatic stumps of curatively resected pancreatic ductal adenocarcinoma (PDAC). Furthermore, clinically relevant POPF seems to be a prognostic factor for tumor recurrence in PDAC.
术后胰腺瘘（POPF）的发病率高达 45%，对整体发病率有重大影响。本研究回顾性评估了 POPF 及其潜在的围手术期临床危险因素，以及其对肿瘤复发的影响。
2007 年至 2016 年间，前瞻性收集了接受胰十二指肠切除术（PD）、胰体尾切除术（DP）或保留十二指肠胰头切除术（DPPHR）的患者的临床数据。开发了一种苦味酸红染色评分，以实现胰腺残端切除边缘的形态学分类。主要终点是主要并发症的发生。次要终点是总生存率和无复发生存率。
340 例患者接受了胰腺切除术，其中 222 例（65.3%）为 PD，87 例（25.6%）为 DP，31 例（9.1%）为 DPPHR。74 例（21.8%）患者发生术后严重并发症。多变量逻辑回归分析显示，POPF 与体重指数（BMI）相关（p=0.025）、住院时间延长（p<0.001）、苦味酸红染色评分高（p=0.049）、术后引流液中淀粉酶或脂肪酶水平升高（p≤0.001）。多变量 Cox 回归分析确定 UICC 分期（p<0.001）、肿瘤分化（p<0.001）、浸润深度（p=0.001）、淋巴结侵犯（p=0.001）以及 POPF B 和 C 级的发生率（p=0.006）为无复发生存率的独立预后标志物。
除了已知的临床病理危险因素 BMI 和引流液中的淀粉酶外，POPF 的发生率与可切除胰腺导管腺癌（PDAC）胰腺残端的苦味酸红染色评分高相关。此外，临床相关的 POPF 似乎是 PDAC 肿瘤复发的预后因素。
