Association Between the Incidence of Pancreatic Fistula After Pancreaticoduodenectomy and the Degree of Pancreatic Fibrosis

Abstract

ObjectiveThe objective of this study is to investigate the association between the incidence of pancreatic fistula after pancreaticoduodenectomy (PD) and the degree of pancreatic fibrosis.MethodBetween January 2013 and December 2016, the analysis of the clinical data of 529 cases of pancreaticoduodenectomy patients of our hospital was performed in a retrospective fashion. The univariate analysis and multivariate analysis were done using the Pearson chi-squared test and binary logistic regression analysis model; correlations were analyzed by Spearman rank correlation analysis. The value of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy was evaluated by the area under the receiver operating characteristic (ROC) curve.ResultsThe total incidence of pancreatic fistula after pancreaticoduodenectomy was 28.5% (151/529). Univariate analysis and multivariate analysis showed that BMI ≥ 25 kg/m2, pancreatic duct size ≤ 3 mm, pancreatic CT value< 30, the soft texture of the pancreas (judged during the operation), and the percent of fibrosis of pancreatic lobule ≤ 25% are prognostic factors of pancreatic fistula after pancreaticoduodenectomy (P < 0.05); the pancreatic CT value and the percent of fibrosis of pancreatic lobule in pancreatic fistula group were both lower than those in non-pancreatic fistula group (P < 0.05). Results indicated that there is a negative correlation between the severity of pancreatic fistula and the pancreatic CT value or the percent of fibrosis of pancreatic lobule (r = − 0.297, − 0.342, respectively). The areas under the ROC curve of the percent of fibrosis of pancreatic lobule and the pancreatic CT value were 0.756 and 0.728, respectively.ConclusionThe degree of pancreatic fibrosis is a prognostic factor which can influence the pancreatic texture and the incidence of pancreatic fistula after pancreaticoduodenectomy. The pancreatic CT value can be used as a quantitative index of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy.

HYAL‐1‐induced autophagy facilitates pancreatic fistula for patients who underwent pancreaticoduodenectomy

“…The pancreatic duct size has been reported as an independent risk factor for POPF . It could be measured at the presumed surgical pancreatic margin or by preoperative CT scan.…”

“…Deng et al suggested that the degree of pancreatic fibrosis is a prognostic factor which influences the pancreatic texture and the incidence of POPF. 16 The pancreatic CT value was used as a quantitative index for calculating the pancreatic fibrosis score to predict the incidence of POPF. Mathur et al revealed that patients with POPF presented decreased pancreatic fibrosis score (<2%).…”

“…The pancreatic duct size has been reported as an independent risk factor for POPF. 16,18,56,57 It could be measured at the presumed surgical pancreatic margin or by preoperative CT scan. In our study, the pancreatic duct size was intraoperatively evaluated by the pancreatic surgeons.…”

“…The softness or hardness of pancreatic texture is decided by the composition of pancreatic parenchyma, which is determined by the fibrous and fatty tissue. Thus, the assessment of pancreatic fibrosis has been elaborated to assess the visualization of pancreatic leakage . In this study, we elucidated that the preoperative concentration of HYAL‐1 in serum, pancreatic fibrosis score, and pancreatic duct size were independent factors for enabling the risk of POPF in patients who underwent PD.…”

“…Thus, the assessment of pancreatic fibrosis has been elaborated to assess the visualization of pancreatic leakage. [16][17][18] In this study, we elucidated that the preoperative concentration of HYAL-1 in serum, pancreatic fibrosis score, and pancreatic duct size were independent factors for enabling the risk of POPF in patients who underwent PD. To investigate the main mechanisms of HYAL-1 on PF, the genomic bioinformatics analysis was assessed for 7944 genes which were correlated with HYAL-1 in pancreatic ductal adenocarcinoma (PDAC) tissues from The Cancer Genome Atlas (TCGA) and the detailed effects of them were estimated.…”