Wang TG, Tian L, Zhang XL, Zhang L, Zhao XL, Kong DS. Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature. World J Clin Cases 2024; 12(9): 1649-1659 [PMID: 38576729 DOI: 10.12998/wjcc.v12.i9.1649]
Corresponding Author of This Article
Tie-Gong Wang, MD, PhD, Attending Doctor, Department of Surgery, Cangzhou Central Hospital, No. 16 Xinhuaxi, Cangzhou 061000, Hebei Province, China. healthbycliff@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2024; 12(9): 1649-1659 Published online Mar 26, 2024. doi: 10.12998/wjcc.v12.i9.1649
Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature
Tie-Gong Wang, Liang Tian, Xiao-Ling Zhang, Lei Zhang, Xiu-Lei Zhao, De-Shuai Kong
Tie-Gong Wang, Lei Zhang, Xiu-Lei Zhao, De-Shuai Kong, Department of Surgery, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
Liang Tian, Xiao-Ling Zhang, Department of Pathology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
Author contributions: Wang TG conceived the study and wrote the manuscript; Tian L and Zhang XL performed research (pathological analyses); Zhang L analyzed data; Zhao XL and Kong DS contributed to the new methods; and all the authors have read and agreed to the published version of the manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tie-Gong Wang, MD, PhD, Attending Doctor, Department of Surgery, Cangzhou Central Hospital, No. 16 Xinhuaxi, Cangzhou 061000, Hebei Province, China. healthbycliff@gmail.com
Received: October 29, 2023 Peer-review started: October 29, 2023 First decision: December 15, 2023 Revised: December 26, 2023 Accepted: March 7, 2024 Article in press: March 7, 2024 Published online: March 26, 2024 Processing time: 147 Days and 16.4 Hours
Abstract
BACKGROUND
Postoperative pancreatic fistula (POPF) contributes significantly to morbidity and mortality after pancreaticoduodenectomy (PD). However, the underlying mechanisms remain unclear. This study explored this pathology in the pancreatic stumps and elucidated the mechanisms of POPF following PD.
CASE SUMMARY
Pathological analysis and 16S rRNA gene sequencing were performed on specimens obtained from two patients who underwent complete pancreatectomy for grade C POPF after PD. Gradient inflammation is present in the pancreatic stump. The apoptosis was lower than that in the normal pancreas. Moreover, neutrophil-dominated inflammatory cells are concentrated in the ductal system. Notably, neutrophils migrated through the ductal wall in acinar duct metaplasia-formed ducts. Additionally, evidence indicates that gut microbes migrate from the digestive tract. Gradient inflammation occurs in pancreatic stumps after PD.
CONCLUSION
The mechanisms underlying POPF include high biochemical activity in the pancreas, mechanical injury, and digestive reflux. To prevent POPF and address pancreatic inflammation and reflux, breaking the link with anastomotic dehiscence is practical.
Core Tip: Postoperative pancreatic fistula (POPF) is a major complication of pancreaticoduodenectomy. However, the underlying mechanisms remain unclear. Compared to the relatively simple histological structure of the gastrointestinal wall, pancreatic stump is undoubtedly the crucial factor in the occurrence of POPF. This study systemically investigated the pathology in pancreatic stumps and provided insights into the underlying mechanisms of POPF. Gradient inflammation and digestive reflux are present in the pancreatic stumps. As the understanding of the role of inflammation in POPF increases, effectively managing the side effects of inflammation will bring about a significant possibility of terminating POPF.
