Skip to main content
SpringerLink
Log in

Number of acinar cells at the pancreatic stump predicts pancreatic fistula after pancreaticoduodenectomy

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To establish if the number of pancreatic acinar cells at the pancreatic cut end is a predictor of postoperative pancreatic fistula (POPF).

Methods

The number of acinar cells was assessed histologically in 121 consecutive patients who underwent pancreaticoduodenectomy (PD) between April, 2012 and July, 2016.

Results

POPF developed in 23 of the 121 patients. Univariate analysis revealed that male sex, long operating time, high volume of blood loss, soft remnant pancreas, large pancreatic duct, and the number of pancreatic acinar cells were significantly associated with POPF. Multivariate analysis revealed that male sex (p = 0.022) and the number of pancreatic acinar cells (p < 0.0001) were independently associated with POPF. In the receiver operating characteristic (ROC) curve analysis, the area under curve was 0.83895 when the cut off value of the number of pancreatic acinar cells to predict POPF was 890. Sensitivity and specificity of the number of pancreatic acinar cells were 82.6 and 77.6%, respectively.

Conclusions

A large number of pancreatic acinar cells at the cut end of the stump is predictive of POPF after PD. Although POPF is associated with multiple factors and the number of acinar cells is only one of these, our study is the first to confirm this common intuition of surgeons, which has not been assessed definitively before.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, Shimada M, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg. 2014;259:773–80.

    Article  PubMed  Google Scholar 

  2. Hirono S, Murakami Y, Tani M, Kawai M, Okada K, Uemura K, et al. Identification of risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy using a 13C-labeled mixed triglyceride breath test. World J Surg. 2015;39:516–25.

    Article  PubMed  Google Scholar 

  3. Motoi F, Egawa S, Rikiyama T, Katayose Y, Unno M. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg. 2012;99:524–31.

    Article  PubMed  CAS  Google Scholar 

  4. Aoki S, Miyata H, Konno H, Gotoh M, Motoi F, Kumamaru H, et al. Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan. J Hepatobiliary Pancreat Sci. 2017;24:243–51.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Krautz C, Nimptsch U, Weber G, Mansky T, Grützmann. R Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg. 2017 (Epub ahead of print).

  6. Otsubo T, Kobayashi S, Sano K, Misawa T, Ota T, Katagiri S, et al. Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons. J Hepatobiliary Pancreat Sci. 2017;24:252–61.

    Article  PubMed  Google Scholar 

  7. Satoi S, Yamamoto T, Yoshitomi H, Motoi F, Kawai M, Fujii T, et al. Developing better practices at the institutional level leads to better outcomes after pancreaticoduodenectomy in 3,378 patients: domestic audit of the Japanese Society of Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2017;24:501–10.

    Article  PubMed  Google Scholar 

  8. Hashimoto D, Chikamoto A, Harimoto N, Ikegami T, Uchiyama H, Yoshizumi T, et al. A comparative study on the complications of conventional and end-to-side inserting pancreatojejunostomy after pancreaticoduodenectomy. Surg Today. 2017;47:238–44.

    Article  PubMed  Google Scholar 

  9. Machado M, Machado M. Systematic use of isolated pancreatic anastomosis after pancreatoduodenectomy: five years of experience with zero mortality. Eur J Surg Oncol. 2016;42:1584–90.

    Article  PubMed  CAS  Google Scholar 

  10. McMillan M, Malleo G, Bassi C, Allegrini V, Casetti L, Drebin J, et al. Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg. 2017;265:1209–18.

    Article  PubMed  Google Scholar 

  11. Relles D, Burkhart R, Pucci M, Sendecki J, Tholey R, Drueding R, et al. Does resident experience affect outcomes in complex abdominal surgery? Pancreaticoduodenectomy as an example. J Gastrointest Surg. 2014;18:279–85.

    Article  PubMed  Google Scholar 

  12. Hashimoto D, Chikamoto A, Ohmuraya M, Hirota M, Baba H. Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy. Surg Today. 2014;44:1207–13.

    Article  PubMed  Google Scholar 

  13. Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, et al. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg. 2011;253:495–501.

    Article  PubMed  Google Scholar 

  14. Low J, Shukla A, Thorn. P Pancreatic acinar cell: new insights into the control of secretion. Int J Biochem Cell Biol. 2010;42:1586–9.

    Article  PubMed  CAS  Google Scholar 

  15. Stockhausen KT. Declaration of Helsinki: revising ethical research guidelines for the 21st century. Med J Aust. 2000;172:252–3.

    PubMed  CAS  Google Scholar 

  16. Dale O, Salo M. The Helsinki Declaration, research guidelines and regulations: present and future editorial aspects. Acta Anaesthesiol Scand. 1996;40:771–2.

    Article  PubMed  CAS  Google Scholar 

  17. Clavien P, Barkun J, de Oliveira M, Vauthey J, Dindo D, Schulick R, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  18. Japan Pancreas Society. General rules for the study of pancreatic cancer (the 6th edition). 2009.

  19. Japan Pancreas Society. General rules for the study of pancreatic cancer (the 7th edition). 2016.

  20. Japanese society of biliary surgery Society. General rules for surgical and pathological studies on cancer of the biliary tract (the 5th ed.). 2003.

  21. Japanese society of hepato-biliary-pancreatic surgery. General rules for surgical and pathological studies on cancer of the biliary tract (the 6th ed.). 2013.

  22. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584–91.

    Article  PubMed  Google Scholar 

  23. DeOliveira M, Winter J, Schafer M, Cunningham S, Cameron J, Yeo C, et al. Assessment of complications after pancreatic surgery a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tani M, Kawai M, Hirono S, Hatori T, Imaizumi T, Nakao A, et al. Use of omentum or falciform ligament does not decrease complications after pancreaticoduodenectomy: nationwide survey of the Japanese Society of Pancreatic Surgery. Surgery. 2012;151:183–91.

    Article  PubMed  Google Scholar 

  25. Kawai M, Yamaue. H Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today. 2010;40:1011–7.

    Article  PubMed  Google Scholar 

  26. Nordback I, Räty S, Laukkarinen J, Järvinen S, Piironen A, Leppiniemi J, et al. A novel radiopaque biodegradable stent for pancreatobiliary applications–the first human phase I trial in the pancreas. Pancreatology. 2012;12:264–71.

    Article  PubMed  CAS  Google Scholar 

  27. Sugiura T, Mizuno T, Okamura Y, Ito T, Yamamoto Y, Kawamura I, et al. Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection. Br J Surg. 2015;102:1561–6.

    Article  PubMed  CAS  Google Scholar 

  28. Okano K, Kakinoki K, Suto H, Oshima M, Kashiwagi H, Yamamoto N, et al. Persisting ratio of total amylase output in drain fluid can predict postoperative clinical pancreatic fistula. J Hepatobiliary Pancreat Sci. 2011;18:815–20.

    Article  PubMed  Google Scholar 

  29. Yoshida H, Yamashita Y, Shimazu T, Cosatto E, Kiyuna T, Taniguchi H, et al. Automated histological classification of whole slide images of colorectal biopsy specimens. Oncotarget. 2017;8:90719–29.

    PubMed  PubMed Central  Google Scholar 

  30. Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD. Risk factors and outcomes in post pancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg. 2004;8:951–9.

    Article  PubMed  Google Scholar 

  31. Fujii T, Kanda M, Nagai S, Suenaga M, Takami H, Yamada S, et al. Excess weight adversely influences treatment length of postoperative pancreatic fistula: a retrospective study of 900 patients. Pancreas. 2015;44:971–6.

    Article  PubMed  Google Scholar 

  32. Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, et al. Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg. 2014;18:1108–15.

    Article  PubMed  Google Scholar 

  33. Kawai M, Hirono S, Okada K, Sho M, Nakajima Y, Eguchi H, et al. Randomized controlled trial of pancreaticojejunostomy versus stapler closure of the pancreatic stump during distal pancreatectomy to reduce pancreatic fistula. Ann Surg. 2016;264:180–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Naoki Umezaki, Daisuke Hashimoto, Shigeki Nakagawa, Yuki Kitano, Kensuke Yamamura, Akira Chikamoto & Hideo Baba

  2. Department of Gastroenterological Surgery, Omuta Tenryo Hospital, 1-100 Tenryo, Omuta, 836-8566, Japan

    Daisuke Hashimoto & Fujio Matsumura

Authors
  1. Naoki Umezaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daisuke Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigeki Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuki Kitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kensuke Yamamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akira Chikamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fujio Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideo Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daisuke Hashimoto.

Ethics declarations

Conflict of interest

No financial support was received for this study. We report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Umezaki, N., Hashimoto, D., Nakagawa, S. et al. Number of acinar cells at the pancreatic stump predicts pancreatic fistula after pancreaticoduodenectomy. Surg Today 48, 790–795 (2018). https://doi.org/10.1007/s00595-018-1656-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-018-1656-5

Keywords

Search

Navigation