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

<h4>Purpose</h4>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 tu...

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Autores principales:	Sameer A Dhayat, Ahmad N J Tamim, Marius Jacob, Georg Ebeling, Laura Kerschke, Iyad Kabar, Norbert Senninger
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1081ad163c504d40962aa599412c89d3
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spelling	oai:doaj.org-article:1081ad163c504d40962aa599412c89d32021-12-02T20:07:16ZPostoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.1932-620310.1371/journal.pone.0252727https://doaj.org/article/1081ad163c504d40962aa599412c89d32021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252727https://doaj.org/toc/1932-6203<h4>Purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Sameer A DhayatAhmad N J TamimMarius JacobGeorg EbelingLaura KerschkeIyad KabarNorbert SenningerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252727 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sameer A Dhayat Ahmad N J Tamim Marius Jacob Georg Ebeling Laura Kerschke Iyad Kabar Norbert Senninger Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.
description	<h4>Purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	Sameer A Dhayat Ahmad N J Tamim Marius Jacob Georg Ebeling Laura Kerschke Iyad Kabar Norbert Senninger
author_facet	Sameer A Dhayat Ahmad N J Tamim Marius Jacob Georg Ebeling Laura Kerschke Iyad Kabar Norbert Senninger
author_sort	Sameer A Dhayat
title	Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.
title_short	Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.
title_full	Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.
title_fullStr	Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.
title_full_unstemmed	Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.
title_sort	postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/1081ad163c504d40962aa599412c89d3
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Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients.

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