Pathologic Assessment of Pancreatic Fibrosis for Objective Prediction of Pancreatic Fistula and Management of Prophylactic Drain Removal After Pancreaticoduodenectomy

Kiyochi, Hidenori; Matsukage, Shouichi; Nakamura, Taro; Ishida, Naoki; Takada, Yasutsugu; Kajiwara, Shinsuke

doi:10.1007/s00268-015-3211-5

Cited by 22 publications

(20 citation statements)

References 32 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 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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 92%

“…The pancreatic tissues were classified into the following four categories: absent (none = 1), 1-30% (mild = 2), 30-70% (moderate = 3), and more than 70% (severe = 4). 18 In addition, serum of another T A B L E 1 (Continued) 62 patients who suffered from PCa were obtained before operation. The fresh serum was stored at −80°C until use.…”

Section: Pathological Assessment Of Pancreatic Fibrosis and Serum Cmentioning

confidence: 99%

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

Fengyu

Yuan

et al. 2019

FASEB j.

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The main mechanism of hyaluronidase 1(HYAL-1) in the development of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) was unknown. In this study, a comprehensive inventory of pre-, intra-, and postoperative clinical and biological data of two cohorts (62 pancreatic cancer [PCa] and 111 pancreatic ductal adenocarcinoma [PDAC]) which could induce POPF were retrospectively analyzed.Then, a total of 7644 genes correlated with HYAL-1 was predicted in PDAC tissues and the enriched pathway, kinase targets and biological process of those correlated genes were evaluated. Finally, a mouse pancreatic fistula (PF) model was first built and in vitro studies were performed to investigate the effects of HYAL-1 on PF progression. Our data indicated that preoperative serum HYAL-1 level, pancreatic fibrosis score, and pancreatic duct size were valuable factors for detecting POPF of Grade B and C. The serum HYAL-1 level of 2.07 mg/ml and pancreatic fibrosis score of 2.5 were proposed as the cutoff values for indicating POPF. The bioinformatic analysis and in vitro and in vivo studies demonstrated that HYAL-1 facilitates pancreatic acinar cell autophagy via the dephosphorylation of adenosine 5'-monophosphate-activated protein kinase (AMPK) and signal transducers and activators of transcription 3 (STAT3) signaling pathways, which exacerbate pancreatic secretion and inflammation. In summary, the preoperative serum HYAL-1 was a significant predictor for POPF in patients who underwent PD. Tumor-induced HYAL-1 is one of core risk in accelerating PF and then promoting pancreatic secretion and acute inflammation response through the AMPK and STAT3-induced autophagy. K E Y W O R D Sautophagy, fibrosis, HYAL-1, pancreaticoduodenectomy, pancreatic fistula | 2525 LI et aL.

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Transpancreatic mattress suture with Vicryl mesh around the stump decreases postoperative pancreatic fistula after distal pancreatectomy

Yoshida

Matsumoto

et al. 2019

J Hepato Biliary Pancreat

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Background Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains the most common surgical complication. We have developed a novel stump closure technique after DP using transpancreatic mattress suture with Vicryl mesh (TMV) and reported our initial findings. The purpose of this study is to evaluate the efficacy of TMV compared to the conventional handsewn stump closure technique (CHS). Methods This retrospective single-center study included 165 consecutive patients who underwent open DP from January 2010 to May 2018. Of these, 71 patients underwent DP using TMV after September 2014 and 94 patients underwent DP with CHS. The surgical outcomes were compared between the two groups. Results Clinically relevant POPF rate in the TMV group was significantly lower than that in the CHS group (5.6% vs. 17.2%, P = 0.027). Morbidity rate was higher in the CHS group than that in the TMV group (16.9% vs. 27.7%, P = 0.104). In the multivariate analysis, absence of additional organ resection (OR 3.57; 95% CI 1.18-10.43; P = 0.025) and TMV (OR 0.24; 95% CI 0.07-0.73; P = 0.010) were identified as independent preventing factors for clinically relevant POPF. Conclusion TMV can be an effective stump closure technique for preventing POPF after DP.

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Pathologic Assessment of Pancreatic Fibrosis for Objective Prediction of Pancreatic Fistula and Management of Prophylactic Drain Removal After Pancreaticoduodenectomy

Abstract: The pathological evaluation of pancreatic fibrosis could objectively predict PF occurrence. Intraoperative assessment of pancreatic fibrosis could be applied to tailor postoperative drain management after PD.

Cited by 22 publications

References 32 publications

Perioperative albumin ratio is associated with post‐operative pancreatic fistula

Perioperative albumin ratio is associated with post‐operative pancreatic fistula

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

Transpancreatic mattress suture with Vicryl mesh around the stump decreases postoperative pancreatic fistula after distal pancreatectomy

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