Protective or Risk Factors for Postoperative Pancreatic Fistulas in Malignant Pathology

Introduction: Malignant tumors are associated with a low incidence of postoperative pancreatic fistulas. The presence of peritumoral fibrosis is considered the protective factor for the development of postoperative pancreatic fistulas after pancreatic resections for pancreatic ductal adenocarcinomas. Methods: We analyzed a series of 109 consecutive patients with pancreatic resections for malignant pathology: pancreatic ductal adenocarcinomas and periampullary adenocarcinomas. The incidence of postoperative pancreatic fistulas has been reported in tumor histological type, in the presence of peritumoral fibrosis, and in the association between adenocarcinomas and areas of acute pancreatitis. The data obtained were processed with the statistical analysis program SPSS, and statistically significant p were considered at a value <0.05. Results: For the entire study group, the incidence of postoperative pancreatic fistulas was 11.01%. The lowest incidence was observed in the group of patients with pancreatic ductal adenocarcinomas (4.06% vs. 25.72% in the group with periampullary adenocarcinoma), with a p = 0.002. The presence of peritumoral fibrous tissue was observed in 49.31% of cases without pancreatic fistulas, and in 54.54% of cases that developed this postoperative complication (p = 0.5). Also, the peritumoral fibrous tissue had a uniform distribution depending on the main diagnosis (56.14% in pancreatic ductal adenocarcinoma group vs. 37.04% in periampullary adenocarcinoma group, with a p = 0.08). In the group of patients who associated areas of acute pancreatitis on the resections, the incidence of postoperative pancreatic fistulas was 7.8 times higher (30% vs. 3.8%, p = 0.026). Conclusions: Peritumoral fibrous tissue was not a factor involved in the developing of postoperative pancreatic fistulas. The association of adenocarciomas with areas of acute pancreatitis has led to a significant increase in postoperative pancreatic fistulas, which is a significant and independent risk factor.

PERIAMPULLARY ADENOCARCINOMA: A RARE REPORT FROM SOUTH INDIA

Periampullary malignancy is the term utilized for neoplasms emerging from the head of pancreas, ampulla of Vater, distal bile pipe and periampullary distinct of duodenum. Of these, the pancreatic adenocarcinoma conveys the most noticeably awful anticipation with greater part of mortalities.Studies have shown that pancreatic carcinoma has the most limited middle endurance of 17.1 months of all periampullary carcinomas. Herein, we present a case of a 63-year-old male patient without any history of trauma or important previous symptoms presented to the tertiary care hospital with compliance of sudden weight loss and abdominal pain over the preceding 3 months. On examination he was deeply jaundice. His laboratory and radiological examination revealed periampullary adenocarcinoma. This individual had successfully underwent Whipple procedure and followed by Chemotherapy. This case is being presented not only the cancer is rare but also to understand and improve better clinical insight on this rare disease