Relationship between grade of fibrosis in pancreatic stump and postoperative pancreatic exocrine activity after pancreaticoduodenectomy: with special reference to insufficiency of pancreaticointestinal anastomosis.
BACKGROUND
Pancreaticoduodenectomy (PD) has become a standard operation for malignant and benign periampullary diseases. Although the operative mortality of PD has decreased to less than 4% in hospitals with many cases of PD, the leakage of pancreaticointestinal anastomosis (PIA) still carries a substantial risk of lethal outcome. The aim of this study was to evaluate the local factors that affect the incidence of PIA leakage by evaluation of exocrine function and fibrosis in the pancreatic remnant following PD.


METHODS
Twenty-eight patients (17 pancreatic disease, 8 bile duct cancers and 3 ampullary cancers) underwent PD with complete extracorporeal pancreatic juice drainage. The cut-end of the pancreatic remnant was histologically studied for its grade of fibrosis in comparison with the exocrine activity of the pancreatic remnant (EAPR) calculated by the value of the product of volume of drained pancreatic juice and its amylase activity. The influences of those factors and other clinicopathologic data on PIA outcome were evaluated.


RESULTS
The histological grade of fibrosis in the pancreatic stump was inversely correlated with EAPR (rs=0.5848, p=0.0011). Three patients had major leakages and 6 had minor leakages of PIA; all the patients with leakages had biliary or ampullary diseases, but not pancreatic diseases. The incidence of leakage of PIA was significantly higher in the patients with high values of EAPR (p<0.05). None with EAPR less than 10(7) had PIA leakage. The incidence of PIA leakage in low-grade fibrosis of the pancreatic stump was significantly higher than that in high-grade fibrosis (p<0.05). Other clinicopathologic data did not influence the incidence of leakage of PIA.


CONCLUSIONS
The degree of fibrosis in the pancreatic stump is significantly related to the EAPR and affects the development of PIA insufficiency as a local factor.
Uchida
Eiji
E
First Department of Surgery, Nippon Medical School, Tokyo, Japan. uchida@nms.ac.jp
Tajiri
Takashi
T
Nakamura
Yoshiharu
Y
Aimoto
Takayuki
T
Naito
Zenya
Z
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000681:Amylases / Q000032:analysis*; D001650:Bile Duct Neoplasms / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D005260:Female; D005355:Fibrosis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010182:Pancreatic Diseases / Q000601:surgery; D010189:Pancreatic Juice / Q000201:enzymology*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D016896:Treatment Outcome
D000681:Amylases