Acinar content at pancreatic resection margin is significantly associated with clinically relevant pancreatic fistula after partial pancreatoduodenectomy.

Autor:	Mintziras I; Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany. Electronic address: ioannis.mintziras@uk-gm.de., Görg M; Institute of Pathology, University Hospital Marburg, Marburg, Germany., Wächter S; Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany., Manoharan J; Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany., Albers MB; Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany., Maurer E; Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany., Kanngiesser V; Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany., Jesinghaus M; Institute of Pathology, University Hospital Marburg, Marburg, Germany., Bartsch DK; Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Mar; Vol. 28 (3), pp. 252-258. Date of Electronic Publication: 2024 Jan 23.
DOI:	10.1016/j.gassur.2023.12.030
Abstrakt:	Background: This study aimed to evaluate the clinical significance of acinar content at the pancreatic resection margin after partial pancreatoduodenectomy (PD). Methods: A total of 228 consecutive patients undergoing PD were included for analysis. Resection margins were assessed for acinar, fibrosis, and fat contents by 2 pathologists blinded to the patients' clinical data. Univariate and multivariable analyses of possible predictors for clinically relevant postoperative pancreatic fistula (cr-POPF) were performed. Results: The median acinar, fibrosis, and fat contents were 70% (IQR, 25%-82%), 13% (IQR, 5%-40%), and 15% (IQR, 9.25%-25%), respectively. The rates of cr-POPF were significantly higher in patients with an acinar content of >70% than in patients with an acinar content of ≤70% (26.4% vs 5.5%, respectively; P < .001). In addition, the rates of postoperative hyperamylasemia (POH) were significantly higher in patients with an acinar content of ≥70% than in patients with an acinar content of ≤70% (55.2% vs 13.8%, respectively; P < .001). The median fat content did not differ between patients with and without cr-POPF (13.0% [IQR, 7.5%-20.0%] vs 15.0% [IQR, 10.0%-30.0%], respectively; P = .06). An acinar content of >70% at the pancreatic resection margin (odds ratio [OR], 4.85; 95% CI, 1.61-14.58; P = .005) and a soft pancreatic texture (OR, 2.82; 95% CI, 1.02-7.76; P = .046) were independent predictive factors of cr-POPF in the multivariable analysis. Conclusion: An acinar content of ≥70% at the pancreatic resection margin was a significant predictive factor for cr-POPF after PD and was also significantly associated with POH, a precursor of cr-POPF after PD in many cases. Fatty infiltration of the pancreatic resection margin was not associated with cr-POPF. Competing Interests: Declaration of competing interest The authors declare no competing interests. (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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