Number of acinar cells at the pancreatic stump predicts pancreatic fistula after pancreaticoduodenectomy
To establish if the number of pancreatic acinar cells at the pancreatic cut end is a predictor of postoperative pancreatic fistula (POPF).
The number of acinar cells was assessed histologically in 121 consecutive patients who underwent pancreaticoduodenectomy (PD) between April, 2012 and July, 2016.
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.
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.
KeywordsPancreaticoduodenectomy Postoperative pancreatic fistula Pancreatic acinar cells
Compliance with ethical standards
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.
- 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.CrossRefPubMedGoogle 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.CrossRefPubMedPubMedCentralGoogle 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).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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle Scholar
- 18.Japan Pancreas Society. General rules for the study of pancreatic cancer (the 6th edition). 2009.Google Scholar
- 19.Japan Pancreas Society. General rules for the study of pancreatic cancer (the 7th edition). 2016.Google Scholar
- 20.Japanese society of biliary surgery Society. General rules for surgical and pathological studies on cancer of the biliary tract (the 5th ed.). 2003.Google Scholar
- 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.Google Scholar