{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T02:54:12Z","timestamp":1777517652201,"version":"3.51.4"},"reference-count":28,"publisher":"Hindawi Limited","license":[{"start":{"date-parts":[[2014,1,1]],"date-time":"2014-01-01T00:00:00Z","timestamp":1388534400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BioMed Research International"],"published-print":{"date-parts":[[2014]]},"abstract":"<jats:p><jats:italic>Introduction.<\/jats:italic>Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF) and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management.<jats:italic>Aim of the Study.<\/jats:italic>Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy.<jats:italic>Patients and Methods.<\/jats:italic>Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue.<jats:italic>Results.<\/jats:italic>Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.009<\/mml:mn><\/mml:math>),<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mtext>BMI<\/mml:mtext><mml:mo>\u2265<\/mml:mo><mml:mn>25<\/mml:mn><\/mml:math>(<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.00<\/mml:mn><mml:mn>2<\/mml:mn><\/mml:math>), prolonged surgery (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.00<\/mml:mn><mml:mn>1<\/mml:mn><\/mml:math>), soft pancreatic texture (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\"><mml:mi>P<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:math>), small pancreatic duct (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\"><mml:mi>P<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:math>), pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M7\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.0<\/mml:mn><mml:mn>31<\/mml:mn><\/mml:math>), large stump area (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M8\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.0<\/mml:mn><mml:mn>01<\/mml:mn><\/mml:math>), and extended stump mobilization (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M9\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.0<\/mml:mn><mml:mn>01<\/mml:mn><\/mml:math>) were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M10\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.0<\/mml:mn><mml:mn>01<\/mml:mn><\/mml:math>).<jats:italic>Discussion and Conclusions.<\/jats:italic>Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy.<\/jats:p>","DOI":"10.1155\/2014\/641239","type":"journal-article","created":{"date-parts":[[2014,5,13]],"date-time":"2014-05-13T17:19:11Z","timestamp":1400001551000},"page":"1-8","source":"Crossref","is-referenced-by-count":32,"title":["Morphohistological Features of Pancreatic Stump Are the Main Determinant of Pancreatic Fistula after Pancreatoduodenectomy"],"prefix":"10.1155","volume":"2014","author":[{"given":"Cristina","family":"Ridolfi","sequence":"first","affiliation":[{"name":"Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Rachele","family":"Angiolini","sequence":"additional","affiliation":[{"name":"Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Gavazzi","sequence":"additional","affiliation":[{"name":"Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Spaggiari","sequence":"additional","affiliation":[{"name":"Department of Pathology, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Carla","family":"Tinti","sequence":"additional","affiliation":[{"name":"Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fara","family":"Uccelli","sequence":"additional","affiliation":[{"name":"Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Madonini","sequence":"additional","affiliation":[{"name":"Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, Rozzano, 20089 Milan, 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