• Annals of surgery · Dec 2023

    Either High or low Risk: The Acinar Score at the Resection Margin Dichotomizes the Risk Spectrum Of Pancreas-specific Complications After Pancreatoduodenectomy.

    • Giampaolo Perri, Giovanni Marchegiani, Stefano Partelli, Valentina Andreasi, Claudio Luchini, Elena Bariani, Elisa Bannone, Francesca Fermi, Paola Mattiolo, Massimo Falconi, Roberto Salvia, and Claudio Bassi.
    • Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
    • Ann. Surg. 2023 Dec 1; 278 (6): e1242e1249e1242-e1249.

    BackgroundPancreatic acinar content (Ac) has been associated with pancreas-specific complications after pancreatoduodenectomy. The aim of this study was to improve the prediction ability of intraoperative risk stratification by integrating the pancreatic acinar score.MethodsA training and validation cohort underwent pancreatoduodenectomy with a subsequent histologic assessment of pancreatic section margins for Ac, fibrosis (Fc), and fat. Intraoperative risk stratification (pancreatic texture, duct diameter) and pancreas-specific complications (postoperative hyperamylasemia [POH], postpancreatectomy acute pancreatitis [PPAP], pancreatic fistula [POPF]) were classified according to ISGPS definitions.ResultsIn the validation cohort (n= 373), the association of pancreas-specific complications with higher Ac and lower Fc was replicated (all P <0.001). In the entire cohort (n= 761), the ISGPS classification allocated 275 (36%) patients into intermediate-risk classes B (POH 32%/PPAP 3%/POPF 17%) and C (POH 36%/PPAP 9%/POPF 33%). Using the acinar score (Ac ≥60% and/or Fc ≤10%), intermediate-risk patients could be dichotomized into a low-risk (POH 5%/PPAP 1%/POPF 6%) and a high-risk (POH 51%/PPAP 9%/POPF 38%) group (all P <0.001). The acinar score AUC for POPF prediction was 0.70 in the ISGPS intermediate-risk classes. Overall, 239 (31%) patients were relocated into the high-risk group from lower ISGPS risk classes using the acinar score.ConclusionsThe risk of pancreas-specific complications appears to be dichotomous-either high or low-according to the acinar score, a tool to better target the application of mitigation strategies in cases of intermediate macroscopic features.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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