Pancreatic leakage test in pancreaticoduodenectomy: relation to degree of pancreatic fibrosis, pancreatic amylase level and pancreatic fistula.

BACKGROUND: Pancreatic fistula is major source of postoperative morbidity or mortality. Soft pancreas has been considered to be one of the most important risk factors for pancreatic fistula. The purpose of the study is to clarify the relationship among extravasation of pancreatic secretions from the pancreatic stump, the pancreatic texture and clinical pancreatic fistula after pancreaticoduodenectomy.
METHODS: For nineteen patients who were treated between July 2007 and August 2008, we performed intraoperative pancreatic leakage test to confirm the extravasation of pancreatic secretions from the pancreatic stump. Degree of fibrosis at the cut surface of the pancreas was reviewed blindly.
RESULTS: Serum pancreatic amylase increased on first postoperative day (POD) and returned to preoperative level on 3POD. These change were inversely correlated with fibrosis (P < 0.001), namely the amylase level in patients with normal to mild fibrotic pancreas showed marked increase on 1POD, but not in those with moderate to severe fibrotic pancreas. Positive pancreatic leakage test was recognized in five patients (26.3%), four of 9 patients with soft pancreas (44.4%) and one of 10 with hard pancreas (10.0%). In soft pancreas, all four cases showing positive leakage test developed pancreatic fistula after pancreaticoduodenectomy, while one positive case in hard pancreas did not develop pancreatic fistula.
CONCLUSION: The extravasation of pancreatic secretions from the pancreatic stump occurred frequently in soft pancreas, which might result in postoperative pancreatic fistula. Therefore we should take care in treating branched duct as well as main pancreatic duct at the pancreatic stump of soft pancreas.