Surgeon vs Pathologist for Prediction of Pancreatic Fistula: Results from the Randomized Multicenter RECOPANC Study

Timme, Sylvia; Kayser, Gian; Werner, Martin; Litkevych, Stanislav; Malyi, Ambrus; Keck, Tobias; Bronsert, Peter; Wellner, Ulrich F.; Petrova, Ekaterina; Honselmann, Kim C.; Bolm, Louisa; Braun, Ruediger; Lapshyn, Hryhoriy

doi:10.1016/j.jamcollsurg.2021.03.024

Cited by 9 publications

(10 citation statements)

References 26 publications

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“…7,10,29 Many attempts have been made to correlate objective, histopathologic pancreatic measures such as Ac, fat content, and fibrosis to postoperative complications. 15,16,30,31 Recently, in the largest series available, Partelli et al 18 found that POPF was associated with Ac and inversely associated with fibrosis but not fat, consistent with previous studies. Moreover, postoperative pancreatitis and the intraoperative finding of a soft gland shared the same histopathologic indicators as POPF, best expressed as an Ac ≥ 60% and fibrosis ≤ 15%.…”

Section: Discussionsupporting

confidence: 70%

“…Many attempts have been made to correlate objective, histopathologic pancreatic measures such as Ac, fat content, and fibrosis to postoperative complications 15,16,30,31 . Recently, in the largest series available, Partelli et al 18 found that POPF was associated with Ac and inversely associated with fibrosis but not fat, consistent with previous studies.…”

Section: Discussionmentioning

confidence: 60%

“…Several attempts have been made to correlate pancreas-specific complications with more objective histopathological measures 15–17 . The proportion of pancreatic Ac, Fc, and fat appears to be strongly correlated with POPF, but a real-time assessment of histopathologic characteristics while in the operating room presents technical challenges, which until now prevented its systematic implementation.…”

mentioning

confidence: 99%

“…Several attempts have been made to correlate pancreasspecific complications with more objective histopathological measures. [15][16][17] The proportion of pancreatic Ac, Fc, and fat appears to be strongly correlated with POPF, but a real-time assessment of histopathologic characteristics while in the operating room presents technical challenges, which until now prevented its systematic implementation. A recent study found that the acinar score, particularly an Ac of ≥60% at the pancreatic resection margin, is an independent predictor of POPF and clinically relevant acute pancreatitis.…”

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confidence: 99%

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Either High or low Risk

et al. 2023

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Background: Pancreatic acinar content (Ac) has been associated with pancreas-specific complications after pancreatoduodenectomy. The aim of this study was to improve the prediction ability of intraoperative risk stratification by integrating the pancreatic acinar score. Methods: A training and validation cohort underwent pancreatoduodenectomy with a subsequent histologic assessment of pancreatic section margins for Ac, fibrosis (Fc), and fat. Intraoperative risk stratification (pancreatic texture, duct diameter) and pancreas-specific complications (postoperative hyperamylasemia [POH], postpancreatectomy acute pancreatitis [PPAP], pancreatic fistula [POPF]) were classified according to ISGPS definitions. Results: In the validation cohort (n = 373), the association of pancreasspecific complications with higher Ac and lower Fc was replicated (all P < 0.001). In the entire cohort (n = 761), the ISGPS classification allocated 275 (36%) patients into intermediate-risk classes B (POH 32%/ PPAP 3%/POPF 17%) and C (POH 36%/PPAP 9%/POPF 33%). Using the acinar score (Ac ≥ 60% and/or Fc ≤ 10%), intermediate-risk patients could be dichotomized into a low-risk (POH 5%/PPAP 1%/POPF 6%) and a high-risk (POH 51%/PPAP 9%/POPF 38%) group (all P < 0.001). The acinar score AUC for POPF prediction was 0.70 in the ISGPS intermediate-risk classes. Overall, 239 (31%) patients were relocated into the high-risk group from lower ISGPS risk classes using the acinar score. Conclusions: The risk of pancreas-specific complications appears to be dichotomous-either high or low-according to the acinar score, a tool to better target the application of mitigation strategies in cases of intermediate macroscopic features.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 60%

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confidence: 99%

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confidence: 99%

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“…Most of the studies were conducted in Germany. [25][26][27][28]32,36,[46][47][48] The other studies were conducted in the USA, 17,20 France, 18,22,49 Italy, 21,43,45,51 Spain, 23,30 Brazil, 24 Belgium, 29,35 Egypt, 31,33 Canada, 34 Bulgaria, 37 China, 39,41 Sweden, 40 Japan, 19,42 India, 44 and Poland. 50 One study was multinational and was conducted at 17 international institutions in Canada, Italy, the USA, and the UK.…”

Section: Resultsmentioning

confidence: 99%

Postoperative pancreatic fistula after pancreaticogastrostomy versus pancreatojejunostomy after pancreatic resection, a comparative systematic review and meta‐analysis

Salman,

Elewa,

Elsherbiny

et al. 2024

World j. surg.

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BackgroundIn patients undergoing pancreaticoduodenectomy (PD), there has been some evidence favoring pancreaticogastrostomy (PG) over pancreatojejunostomy (PJ) in the occurrence of postoperative pancreatic fistulas (POPF) and considering PG as a safer anastomotic technique. However, other publications revealed comparable incidences of POPF attributed to both techniques. The current work attempts to reach a more consolidated conclusion about such an issue.MethodsThis is a systematic review and meta‐analysis that analyzed the studies comparing PG and PJ during PD in terms of the rate of POPF occurrence. Studies were obtained by searching the Scopus, PubMed Central, and Cochrane Central Register of Controlled Trials databases.Results35 articles published between 1995 and 2022 presented data from 14,666 patients; 4547 underwent PG and 10,119 underwent PJ. Statistically significant lower rates of POPF (p = 0.044) and clinically relevant CR‐POPF (p = 0.043) were shown in the PG group. The post‐pancreatectomy hemorrhage (PPH) was significantly higher in the PG group, while no significant difference was found between the two groups in the clinically significant PPH. No statistically significant differences were found regarding the amount of intraoperative blood loss, length of hospital stay, DGE, overall morbidity rates, reoperation rates, or mortality rates. The percentage of male sex in the PG group and the percentage of soft pancreas in the PJ group seem to influence the odds ratio of CR‐POPF (p = 0.076 and 0.074, respectively).ConclusionThe present study emphasizes the superiority of PG over PJ regarding CR‐POPF rates. Higher rates of postoperative hemorrhage were associated with PG. Yet, the clinically significant hemorrhage rate was comparable between the two groups.

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