title: Morphohistological features of pancreatic stump are the main determinant of pancreatic fistula after pancreatoduodenectomy.
abstract: BACKGROUND
  Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF) and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management.
  
  
  OBJECTIVE
  Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy.
  
  
  METHODS
  Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue.
  
  
  RESULTS
  Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex (P = 0.009), BMI ≥ 25 (P = 0.002), prolonged surgery (P = 0.001), soft pancreatic texture (P < 0.001), small pancreatic duct (P < 0.001), pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin (P = 0.031), large stump area (P = 0.001), and extended stump mobilization (P = 0.001) were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF (P = 0.001).
  
  
  CONCLUSIONS
  Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy.
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ridolfi
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Maria Rachele
authors.initials: MR
authors.lastname: Angiolini
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gavazzi
authors.affiliation: Department of Pathology, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Spaggiari
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Maria Carla
authors.initials: MC
authors.lastname: Tinti
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Fara
authors.initials: F
authors.lastname: Uccelli
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Madonini
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.affiliation: Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
mesh_terms: D000368:Aged; D005260:Female; D005355:Fibrosis / Q000473:pathology / Q000601:surgery; D006801:Humans; D007249:Inflammation / Q000473:pathology / Q000601:surgery; D008297:Male; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010185:Pancreatic Fistula / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods; D011183:Postoperative Complications / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors