What is the nature of pancreatic consistency? Assessment of the elastic modulus of the pancreas and comparison with tactile sensation, histology, and occurrence of postoperative pancreatic fistula after pancreaticoduodenectomy

Sugimoto, Motokazu; Takahashi, Shinichiro; Kojima, Masaru; Gotohda, Naoto; Kato, Yukio; Kawano, Shingo; Ochiai, Atsushi; Konishi, Masaru

doi:10.1016/j.surg.2014.05.015

Cited by 50 publications

(48 citation statements)

References 26 publications

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“…[3][4][5][6] Besides these evidences, many efforts have been made to reduce incidence of POPF: modifications of surgical procedures, use of stent for internal or external drainage of pancreatic juice, prophylactic administration of somatostatin, management of abdominal drains. [14][15][16] Serum albumin predicts pancreatic fistula E603 Recent studies suggested the opportunity to assess histologically the grade of pancreatic fibrosis in order to define objective and reproducible parameters able to define the role of pancreas consistency in POPF risk.…”

Section: Discussionmentioning

confidence: 99%

Perioperative albumin ratio is associated with post‐operative pancreatic fistula

Gruppo

Angriman

Martella

et al. 2017

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Perioperative albumin ratio is associated with post‐operative pancreatic fistula

Gruppo

Angriman

Martella

et al. 2017

ANZ Journal of Surgery

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“…The azan‐positive areas and α‐SMA‐positive areas were calculated using the tracing algorithm of the WinROOF version 6.5 software (Mitani Corporation, Tokyo, Japan). The azan‐positive areas and α‐SMA‐positive areas in ×40 pictures were taken and calculated, using each color‐detecting algorithm of the software . The numbers of CD31‐positive vessels in ×20 pictures were counted manually.…”

Section: Methodsmentioning

confidence: 99%

“…The azan-positive areas and α-SMA-positive areas in ×40 pictures were taken and calculated, using each color-detecting algorithm of the software. 16 The numbers of CD31-positive vessels in ×20 pictures were counted manually. The numbers of CD3 (T cell), CD20 (B cell), and CD68 (macrophage) positive cells were counted manually at a magnification of ×40.…”

Section: Histochemical and Immunohistochemical Study Of The Stromal Cmentioning

confidence: 99%

Histological differences between preoperative chemoradiotherapy and chemotherapy for rectal cancer: a clinicopathological study

Sakuyama

Kojima

Kawano

et al. 2016

Pathology International

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Pathological studies on the different histological effects between neoadjuvant chemotherapy (NAC) and preoperative chemoradiation therapy (preoperative CRT) have not been performed. The purpose of this study is to elucidate the histological differences in tissue received from NAC and preoperative CRT for rectal cancer to evaluate whether a pathological assessment method used after CRT can be applied for NAC. One hundred and thirty-eight patients were enrolled in this study; 88 patients underwent their operations after preoperative CRT or NAC, and 50 patients underwent surgery only. Residual tumor area was measured using morphometry software and we compared the stromal component of myofibroblasts, immune cells, and vasculature to elucidate the difference of therapeutic effect between them. The grade of reduction after preoperative CRT was more prominent than that seen in NAC. Also, ypT downstaging was more prominent in preoperative CRT than in NAC, and ypN downstaging was more frequent in NAC than in preoperative CRT. Preoperative CRT showed more marked myofibroblasts and fewer immune cells than did NAC, which indicates different effects on the cancer microenvironment. Our histological results suggest different effects between NAC and preoperative CRT on tumor tissue. The best assessment method available for a variable therapeutic protocol should be further investigated.

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“…In contrast, a hard pancreatic remnant may offer better suture-holding capacity, thereby reducing the risk for POPF after PD. Sugimoto et al [54] conducted an ex vivo evaluation of pancreatic consistency using an automatic indentation apparatus to measure the tissue elasticity (elastic modulus, EM) on 59 PD specimens immediately after surgery. They found that the EM of the resected pancreas correlated well with the histological degree of pancreatic fibrosis, pancreatic firmness perceived by the surgeon, and the occurrence of POPF after PD, and that patients with a pancreatic EM of <3.0 kPa had an increased risk for POPF.…”

Section: Discussionmentioning

confidence: 99%

“…The intraoperative application of elastometric or sclerometric instruments [54,55] can provide objective and quantitative information on the pancreas in relation to POPF. However, a preoperative diagnostic tool that offers a platform for reliably predicting the risk of developing POPF is more desirable.…”

Section: Discussionmentioning

confidence: 99%

Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy

2017

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In performing pancreaticoduodenectomy (PD) or when conducting clinical trials involving PD procedure, a universal platform for predicting the risk of postoperative pancreatic fistula (POPF) is indispensable. In this article, the most significant imaging studies that focused on the objective preoperative assessment of pancreatic pathologies in association with the occurrence of POPF after PD were reviewed. Several recently developed imaging modalities can objectively predict the occurrence of POPF after PD by assessing the elasticity, fibrosis, and fatty infiltration of the pancreas. These valuable imaging modalities include: (1) acoustic radiation force impulse ultrasound (US) electrography which provides information about the elastic properties of the pancreas; (2) contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) with/without contrast-enhancement which reflect the histological degree of pancreatic fibrosis; and (3) multi-detector row CT and/or MRI which reflects the microscopic fatty infiltration of the pancreas. The precise and objective preoperative risk assessment of POPF enables surgeons to customize appropriate management strategies for individual patients undergoing PD. This would be also beneficial for stratifying patients for enrolment in relevant studies that involve pancreatic head resection, as objective criteria could be set for the definitive evaluation of collected data related to surgical outcomes across different institutions and surgeons.

show abstract

What is the nature of pancreatic consistency? Assessment of the elastic modulus of the pancreas and comparison with tactile sensation, histology, and occurrence of postoperative pancreatic fistula after pancreaticoduodenectomy

Cited by 50 publications

References 26 publications

Perioperative albumin ratio is associated with post‐operative pancreatic fistula

Perioperative albumin ratio is associated with post‐operative pancreatic fistula

Histological differences between preoperative chemoradiotherapy and chemotherapy for rectal cancer: a clinicopathological study

Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy

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