Objective parameters aid the prediction of fistulas in pancreatic surgery

Felix,Klaus; Schuck,Anna; Gaida,Matthias  M.; Hinz,Ulf; Dovzhanskiy,Dmitriy; Werner,Jens

doi:10.3892/etm.2014.1829

September-2014 Volume 8 Issue 3

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September-2014 Volume 8 Issue 3

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Article

Objective parameters aid the prediction of fistulas in pancreatic surgery

Authors:
- Klaus Felix
- Anna Schuck
- Matthias M. Gaida
- Ulf Hinz
- Dmitriy Dovzhanskiy
- Jens Werner
View Affiliations / Copyright

Affiliations: Department of General Surgery, University of Heidelberg, Heidelberg D‑69120, Germany, Institute of Pathology, University of Heidelberg, Heidelberg D‑69120, Germany
Pages: 719-726
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Published online on: July 7, 2014

https://doi.org/10.3892/etm.2014.1829
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Abstract

Insufficiency of pancreatic anastomosis with leakage from the pancreatic stump and the development of fistulas account for the majority of surgical complications following pancreatic resection, which are often life threatening. The cause of pancreatic fistulas of the remnant tissue on a molecular level remains unclear. Thus, the aim of the present study was to investigate risk factors associated with postoperative pancreatic fistula (POPF) formation and to define parameters that may predict the resection outcome. Pancreatic resection margins were selected from 31 patients, including 16 individuals without and 15 patients with POPF, to analyze the degree of fibrosis, lipomatous atrophy, inflammatory activity and infiltration. Wound healing factors were assessed by luminex technology using tissue homogenates, while the distribution in situ was assessed using immunohistochemistry. Increased chronic inflammatory infiltration, a higher degree of fibrosis and a reduction in lipomatous atrophy were observed in the samples without anastomotic fistulas. Multiplex analysis of 38 wound healing factors demonstrated significantly higher levels of interleukin (IL)‑6, ‑8 and ‑12, glucagon‑like peptide‑1 and matrix metalloproteinase (MMP)‑1, ‑2, ‑3 and ‑12 in the group without fistulas, while lower concentrations of IL‑10, IL‑17 and gastric inhibitory polypeptide were observed. Therefore, the observations of the present study indicated that increased inflammatory infiltration and inflammatory activity, as well as higher concentrations of proinflammatory cytokines and higher MMP levels at the resection margins, predisposed individuals to a lower fistula incidence rate following pancreatic resection.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Objective parameters aid the prediction of fistulas in pancreatic surgery

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