Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients

Postoperative pancreatic fistula (POPF) with reported incidence rates up to 45% contributes substantially to overall morbidity. In this study, we conducted a retrospective evaluation of POPF along with its potential perioperative clinical risk factors and its effect on tumor recurrence. Clinical dat...

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Bibliographic Details
Published in:	PloS one Vol. 16; no. 6; p. e0252727
Main Authors:	Dhayat, Sameer A, Tamim, Ahmad N J, Jacob, Marius, Ebeling, Georg, Kerschke, Laura, Kabar, Iyad, Senninger, Norbert
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 04-06-2021 Public Library of Science (PLoS)
Subjects:	Aged Cancer Care and treatment Complications Disease-Free Survival Female Fistula Humans Male Medicine and Health Sciences Middle Aged Neoplasm Recurrence, Local - pathology Pancreatectomy - adverse effects Pancreatic cancer Pancreatic Fistula - etiology Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - adverse effects Physical Sciences Postoperative Complications - etiology Relapse Research and Analysis Methods Retrospective Studies Risk Factors Surgery Germany
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Summary:	Postoperative pancreatic fistula (POPF) with reported incidence rates up to 45% contributes substantially to overall morbidity. In this study, we conducted a retrospective evaluation of POPF along with its potential perioperative clinical risk factors and its effect on tumor recurrence. Clinical data on patients who had received pancreatoduodenectomy (PD), distal pancreatectomy (DP), or duodenum-preserving pancreatic head resection (DPPHR) were prospectively collected between 2007 and 2016. A Picrosirius red staining score was developed to enable morphological classification of the resection margin of the pancreatic stump. The primary end point was the development of major complications. The secondary end points were overall and recurrence-free survival. 340 patients underwent pancreatic resection including 222 (65.3%) PD, 87 (25.6%) DP, and 31 (9.1%) DPPHR. Postoperative major complications were observed in 74 patients (21.8%). In multivariable logistic regression analysis, POPF correlated with body mass index (BMI) (p = 0.025), prolonged stay in hospital (p<0.001), high Picrosirius red staining score (p = 0.049), and elevated postoperative levels of amylase or lipase in drain fluid (p≤0.001). Multivariable Cox regression analysis identified UICC stage (p<0.001), tumor differentiation (p<0.001), depth of invasion (p = 0.001), nodal invasion (p = 0.001), and the incidence of POPF grades B and C (p = 0.006) as independent prognostic markers of recurrence-free survival. Besides the known clinicopathological risk factors BMI and amylase in the drain fluid, the incidence of POPF correlates with high Picrosirius red staining score in the resection margins of the pancreatic stumps of curatively resected pancreatic ductal adenocarcinoma (PDAC). Furthermore, clinically relevant POPF seems to be a prognostic factor for tumor recurrence in PDAC.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0252727