Histological and oncological determinants of postpancreatectomy acute pancreatitis following pancreatoduodenectomy.
Aim: This study aimed to evaluate the incidence of postpancreatoduodenectomy acute pancreatitis (PPAP) and analyze its association with histological and oncological features of the resected tumors.
Materials and Methods: Data from 296 patients who underwent PD between 2014 and 2023 were analyzed. The intergroup analysis compared patients in the PPAP (n=126) and no-PPAP (n=170) groups regarding tumor histology, stage, differentiation, resection margin status, and type of PD.
Results: PPAP occurred in 42,6% of cases, and clinically relevant PPAP in 30,1%. PPAP was more common in patients with cystic pancreas neoplasms (22,4% in the PPAP group vs. 9,0% in the no-PPAP group, p=0,001) and duodenal adenocarcinoma (4,0% vs. 0,6%, p=0,04) and tended to occur more often in distal bile duct adenocarcinoma (10.4% vs. 4.8%, p=0.07). In contrast, patients with pancreatic ductal adenocarcinoma had a lower PPAP rate (22,4% vs. 49,1%, p<0,0001). The tumor size (T1-T4) and differentiation (G1-G4) did not affect PPAP incidence. A higher incidence of PPAP was observed in the N0 group (46,7% vs. 30,8%, p=0,03), as well as in patients with R0 resections (91,0% vs. 70,3%, p=0,0006). Standard PD was also associated with a higher frequency of this complication (the difference at borderline significance: p=0,05).
Conclusions: The incidence of PPAP is associated with certain histological tumor types and the extent of surgery. Tumor size and grade of differentiation had no significant impact, while N0 lymph node status and R0 resection margins were associated with higher PPAP incidence.
Materials and Methods: Data from 296 patients who underwent PD between 2014 and 2023 were analyzed. The intergroup analysis compared patients in the PPAP (n=126) and no-PPAP (n=170) groups regarding tumor histology, stage, differentiation, resection margin status, and type of PD.
Results: PPAP occurred in 42,6% of cases, and clinically relevant PPAP in 30,1%. PPAP was more common in patients with cystic pancreas neoplasms (22,4% in the PPAP group vs. 9,0% in the no-PPAP group, p=0,001) and duodenal adenocarcinoma (4,0% vs. 0,6%, p=0,04) and tended to occur more often in distal bile duct adenocarcinoma (10.4% vs. 4.8%, p=0.07). In contrast, patients with pancreatic ductal adenocarcinoma had a lower PPAP rate (22,4% vs. 49,1%, p<0,0001). The tumor size (T1-T4) and differentiation (G1-G4) did not affect PPAP incidence. A higher incidence of PPAP was observed in the N0 group (46,7% vs. 30,8%, p=0,03), as well as in patients with R0 resections (91,0% vs. 70,3%, p=0,0006). Standard PD was also associated with a higher frequency of this complication (the difference at borderline significance: p=0,05).
Conclusions: The incidence of PPAP is associated with certain histological tumor types and the extent of surgery. Tumor size and grade of differentiation had no significant impact, while N0 lymph node status and R0 resection margins were associated with higher PPAP incidence.