Background

Postoperative pancreatic fistula (POPF) remains a prominent complication following pancreatic cancer resections. The primary aim of this study was to evaluate the histological changes that occur in the pancreas due to neoadjuvant therapy (NAT) by comparing the acinar, collagen and fat scores in resected PDAC specimens of patients who did and did not receive NAT. Secondary aims included (1) the difference in rates of POPF in PDAC patients who received NAT versus upfront resection; and (2) the association between acinar/collagen/fat scores and the development of POPF.

Methods

Consecutive patients who underwent pancreaticoduodenectomy for PDAC, with and without NAT were included for analysis. Acinar, collagen and fat scores were determined from histology slides of the pancreatic resection margin.

Results

One hundred and thirty-four patients were included. There was a significant decrease in the median acinar score (48 vs 23, p = 0.003) and increase in the collagen score (28 vs 50, p = 0.011) for patients who received NAT and a significant correlation with the number of cycles of NAT. This study found no statistical difference between NAT and the development of POPF.

Conclusion

The use of NAT in the treatment of PDAC changes the composition of the pancreas.

中文翻译：

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胰腺癌的新辅助治疗改变了胰腺实质的组成

背景

术后胰瘘 (POPF) 仍然是胰腺癌切除术后的一个突出并发症。本研究的主要目的是通过比较接受和未接受 NAT 的患者切除的 PDAC 标本中的腺泡、胶原蛋白和脂肪评分来评估新辅助治疗 (NAT) 导致的胰腺组织学变化。次要目标包括（1）接受 NAT 与前期切除的 PDAC 患者 POPF 发生率的差异；(2)腺泡/胶原/脂肪评分与POPF发展的关系。

方法

连续接受 PDAC 胰十二指肠切除术的患者，无论有无 NAT，均被纳入分析。从胰腺切除边缘的组织学载玻片确定腺泡、胶原蛋白和脂肪评分。

结果

包括 134 名患者。接受 NAT 的患者中位腺泡评分显着降低（48 对 23，p = 0.003），胶原蛋白评分增加（28 对 50，p = 0.011），并且与 NAT 周期数显着相关. 本研究发现 NAT 与 POPF 发展之间没有统计学差异。

结论

在 PDAC 的治疗中使用 NAT 会改变胰腺的组成。