La fréquence élevée des cellules acineuses et le degré d'infiltration adipeuse au niveau de la tranche de section pancréatique influencent-ils le taux de survenue de fistules pancréatiques après une duodenopancreatectomie céphalique ?

AbstractObjective: to evaluate the role of acinar cells density, pancreatic fatty infiltration and fibrosis in the developement of major complications after pancreaticoduodenectomy (PD).Material and Methods: we prospectively collected a series of 46 consecutive PD performed in our center. The variables considered were: age, gender, ASA score, pancreatic texture, Wirsung diameter, postoperative mortality and morbility (pancreatic fistula - PF, post pancreatectomy haemorrage - PPH, delayed gastric emptying - DGE), hospital stay, histology and preoperative biliary drainage. Both univariate and multivariate models were used to determine factors correlated to PF. Analisys regarding histological findings (pancreatic fibrosis, pancreatic fatty infiltration, acinar cell frequency) and correlation with PF was conducted. Statistical analysis was performed using SPSS v10.0. Differences between categorical variables were evaluated by X2 analysis, while Student’s T test was used for all comparison among continuous variables. Univariate and Multivariate analysis were performed using SPSS v 10.0.Results: most of the patients were resected for malignant diseases (19 pancreatic head carcinoma, 2 distal biliary tract carcinoma, 18 ampullary malignancy, 2 neuroendocrine tumors, 1 duodenal cancer, 1 degenerated IPMN, 3 non malignant diseases). All patients underwent standard PD with dunking, sutureless, end to end PJ anastomosis with distal gastrectomy and end to side hepatico-jejunostomy. Overall morbility rate and operative mortality rate were respectively 43,2 and 5 %. PF rate was 21,7 %. PPH rate was 17,8 % and DGE 27,3 %. At univariate analysis PF rate correlates with Wirsung diameter < 3 mm (p=0,015 OR: 6,25), pancreatic cancer (p=0,016 OR = 0,37), soft pancreatic texture ( p=0,001 OR= 0,37), male gender (p=0,01). 45,5% of high fatty pancreas patients developed PF; 88,9% of patients with PF had high frequency of acinar cells; patients with fatty or high fatty pancreas, in more than 70 % of cases had high acinar cells density. No correlation was found between BMI and the severity of fatty infiltration score and between BMI > 25 and PF. Conclusions: In our series PF fistula rate correlates with pancreatic texture and wirsung diameter. BMI was not usefull to identify PF high risk patients and it has not been shown to be an accurate index of pancreatic fatty infiltration. High acinar cells frequency on pancreatic cut edge could be an interesting marker to identify high risk pancreas.Intervenant : P BACHELIER (Strasbourg)