Journal of Nippon Medical School: Vol.69 No.6 page.549

Journal of Nippon Medical School

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ArticleTitle Relationship Between Grade of Fibrosis in Pancreatic Stump and Postoperative Pancreatic Exocrine Activity After Pancreaticoduodenectomy: With Special Reference to Insufficiency of Pancreaticointestinal Anastomosis

AuthorList Eiji Uchida¹, Takashi Tajiri¹, Yoshiharu Nakamura¹, Takayuki Aimoto¹ and Zenya Naito²

Affiliation ¹First Department of Surgery, Nippon Medical School, ²Department of Pathology, Nippon Medical School

Language EN

Volume 69

Issue 6

Year 2002

Page 549-556

Received May 27, 2002

Accepted July 11, 2002

Keywords pancreaticoduodenectomy, periampullary disease, complication, exocrine activity, fibrosis

Abstract
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.
Method: 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 10⁷ 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.

Correspondence to Eiji Uchida, First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
uchida@nms.ac.jp

ArticleTitle	Relationship Between Grade of Fibrosis in Pancreatic Stump and Postoperative Pancreatic Exocrine Activity After Pancreaticoduodenectomy: With Special Reference to Insufficiency of Pancreaticointestinal Anastomosis
AuthorList	Eiji Uchida¹, Takashi Tajiri¹, Yoshiharu Nakamura¹, Takayuki Aimoto¹ and Zenya Naito²
Affiliation	¹First Department of Surgery, Nippon Medical School, ²Department of Pathology, Nippon Medical School
Language	EN
Volume	69
Issue	6
Year	2002
Page	549-556
Received	May 27, 2002
Accepted	July 11, 2002
Keywords	pancreaticoduodenectomy, periampullary disease, complication, exocrine activity, fibrosis
Abstract	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. Method: 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 10⁷ 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.
Correspondence to	Eiji Uchida, First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan uchida@nms.ac.jp