Pancreatic Inflammation and Proenzyme Activation Are Associated With Clinically Relevant Postoperative Pancreatic Fistulas After Pancreas Resection
| Autor: | Christian M Kühlbrey, Esther A. Biesel, Ulrich T. Hopt, Carina Wüster, Stefan Fichtner-Feigl, Uwe A. Wittel, Haoyun Shi |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Trypsinogen Inflammation Anastomosis Trypsin medicine.disease Gastroenterology Cathepsin B 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine medicine.anatomical_structure chemistry 030220 oncology & carcinogenesis Internal medicine medicine Pancreatitis 030211 gastroenterology & hepatology Surgery medicine.symptom Trypsinogen activation Pancreas business medicine.drug |
| Zdroj: | Annals of Surgery. 272:863-870 |
| ISSN: | 1528-1140 0003-4932 |
| Popis: | Objective We investigated the activation of pancreatic proenzymes and signs of peripancreatic inflammation in patients with clinically relevant postoperative pancreatic fistulas (POPFs). Summary background data An increase of systemic amylase concentration was associated with POPFs. This suggested parallels in the pathomechanisms between the development of POPFs and pancreatitis. Methods Trypsinogen, procathepsin B, and IL-6 concentrations as well as cathepsin B, myeloperoxidase and trypsin activities were determined throughout the first 7 postoperative days in drain fluids of 128 consecutive patients after pancreas resection. Histology and immunohistochemistry were performed in pancreatic specimens after total pancreatectomy due to complications and after placing experimental pancreatic sutures in the pancreatic tail of C57/Bl6 mice. Results Trypsin activity, cathepsin B activity and myeloperoxidase activity on the first postoperative day were elevated and predictive for clinically relevant pancreatic fistulas. Drain fluid stabilized trypsin activity and prevented the activation of the cascade of digestive enzymes. Leukocytes were the source of cathepsin B in drain fluid. Findings differed between fistulas after distal pancreatectomy and pancreatoduodenectomy. Immunohistochemistry of the pancreatic remnant revealed an inflammatory infiltrate expressing cathepsin B, independent of the presence of pancreatic fistulas. The infiltrate could be reproduced experimentally by sutures placed in the pancreatic tail of C57/Bl6 mice. Conclusions Trypsinogen activation, increased cathepsin B activity and inflammation around the pancreato-enteric anastomosis on post operative day 1 are associated with subsequent clinically relevant POPFs after pancreatoduodenectomy. The parenchymal damage seems to be induced by placing sutures in the pancreatic parenchyma during pancreatic surgery. |
| Databáze: | OpenAIRE |
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