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Pancreatic fistulas following distal pancreatectomy are unrelated to the texture quality of the pancreas

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Abstract

Purpose

The relevance of pancreatic texture for pancreatic fistula (POPF) formation after distal pancreatectomy (DP) remains ill defined. Recent POPF definition adjustments and common subjective pancreatic texture assessment are further drawbacks in the investigation of pancreatic texture as a factor for POPF development after DP.

Methods

The predictive value of pancreatic texture by histologic assessment was investigated for POPF formation after DP, respecting the updated 2016 fistula definition. Histologic evaluation at the resection margin included amount of steatosis, degree of fibrosis, and pancreatic duct size.

Results

A total of 102 patients who underwent DP were included. Thirty-six patients developed POPF. There was no difference in histologic variables in patients with and without POPF. In the univariate analysis, none of the three histologic features showed significant correlation with POPF formation. The ROC (receiver operating characteristic) curve demonstrated poor utility for the grade of steatosis 0.481 ± 0.058 (p = 0.75) and grade of fibrosis 0.466 ± 0.058 (p = 0.57) as predictive factors for POPF formation.

Conclusion

Results indicate that pancreatic texture does not predict POPF formation following DP. This is particularly relevant in the context of the increasing use of robotic and laparoscopic approaches for DPs with limited clinical pancreatic texture assessment by palpation.

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Data availability

Data are available upon reasonable request by corresponding author.

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Author information

Author notes

  1. Daniela Lenggenhager, Christoph Tschuor and Pierre-Alain Clavien contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Dilmurodjon Eshmuminov, Joshua Kapp, Christian Oberkofler, Henrik Petrowsky, Christoph Tschuor & Pierre-Alain Clavien

  2. Medical Faculty of University Zurich, Zurich, Switzerland

    Iryna Karpovich

  3. Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland

    Antonia Töpfer, Katharina Endhardt & Daniela Lenggenhager

Authors
  1. Dilmurodjon Eshmuminov
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  2. Iryna Karpovich
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  3. Joshua Kapp
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  4. Antonia Töpfer
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  5. Katharina Endhardt
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  6. Christian Oberkofler
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  7. Henrik Petrowsky
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  8. Daniela Lenggenhager
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  9. Christoph Tschuor
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  10. Pierre-Alain Clavien
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Corresponding author

Correspondence to Pierre-Alain Clavien.

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The authors declare that they have no conflict of interest.

Ethics approval

The local ethics committee approved the study protocol (BASEC-Nr: 2017-00719 national clinical trial number).

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Not applicable in retrospective study.

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Eshmuminov, D., Karpovich, I., Kapp, J. et al. Pancreatic fistulas following distal pancreatectomy are unrelated to the texture quality of the pancreas. Langenbecks Arch Surg 406, 729–734 (2021). https://doi.org/10.1007/s00423-020-02071-y

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  • DOI: https://doi.org/10.1007/s00423-020-02071-y

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