[The impact of morphologic and physiologic peculiarities of the pancreas on pancreas-related complications following pancreatoduodenectomy]

The factors influencing failure of pancreaticojejunostomy following pancreatoduodenectomy are still ill-defined. Our previous study showed that age of patient, bilirubinemia or malignant nature of peripancreatic tumor had no impact on pancreas-related morbidity following pancreatoduodenectomy. The hypothesis is that it could be influenced by the level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function. Aim of the study was to analyze the impact of morphologic and physiologic peculiarities of pancreatic remnant on development of pancreas-related morbidity after Whipple procedure.We have analyzed retrospectively clinical data of 122 patients who have undergone pancreatoduodenectomy in the Department of Surgery of Kaunas University of Medicine Hospital during 1995-2001. Fibrosis of pancreatic parenchyma, diameter of main pancreatic duct, and preoperative exocrine function were evaluated. Pancreas-related morbidity was determined as either peripancreatic sepsis or pancreatic fistula. Fibrosis of pancreatic remnant was determined by computer-aided morphometric analysis. The exocrine pancreatic function was tested the day before surgery by Pancreatic Elastase-1 Stool test.One hundred twenty two patients have undergone pancreatoduodenectomy during 1995-2001. Pancreas-related morbidity was encountered in 27 (22.13%) cases, pancreatic fistula in 13 (10.65%) and peripancreatic sepsis in 14 (11.47%). Univariate analysis shows that diameter of main pancreatic duct and level of postoperative amylasemia were significantly different between the groups with and without pancreatic complications (p=0.001 and p=0.002, respectively) as well as there was significant difference of pancreatic exocrine function and fibrosis between the groups of patients who developed pancreas-related complications and who did not (p=0.003 and p=0.026, respectively). When logistic regression analysis was applied on those 4 variables, only one independent risk factor - exocrine pancreatic function at the cut-off of stool Elastase 100 micro g/g was revealed (odds ratio 21.6). The sensitivity of the Stool Elastase-1 test was 0.86, specificity 0.78, positive predictive value - 0.55 and negative predictive value - 0.95.The level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function mainly influence pancreas-related morbidity following pancreatoduodenectomy. Exocrine pancreatic function measured by Stool Elastase-1 test is helpful for the detection of the group of patients with minimal risk for pancreas-related morbidity after pancreatoduodenectomy.