Pancreatic fistula after pancreaticoduodenectomy: Risk factors and preventive strategies

Purpose: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. This study aimed to investigate the risk factors and preventive strategies for POPF after PD. Materials and Methods: We retrospectively reviewed 301 consecutive patients who underwent PD at our hospitals between January 2011 and December 2017. We analyzed the pancreatic fistula rate according to the clinical characteristics, pathologic and laboratory findings, and the anastomotic methods and summarized the prevention measures. Results: Postoperative morbidities included pancreatic leakage in 10.30% (31/301), delayed gastric emptying in 22.92% (69/301), abdominal infection in 6.98% (21/301), post-PD hemorrhage in 4.65% (14/301), and bile leakage in 4.98% (15/301), and the mortality rate was 2.33% (7/301). POPF was the most prominent factor for preoperative morbidity. Significant risk factors for pancreatic fistula were a soft pancreas, small pancreatic duct, tumor location, and interrupted anastomosis. Of these, soft texture, pancreatic duct <4 mm, and end-to-end anastomosis through hand suture closure were independent risk factors on multivariate analysis, while interrupted anastomosis, internal stent, and somatostatin use were risk factors in the high-risk pancreas subgroup. Conclusions: Our study demonstrated that pancreatic fistula is related to a soft texture and small pancreatic duct. The surgeon must consider these risk factors when performing PD. Thus, we propose a risk- and indication-adapted choice of anastomosis or an individualized approach for the pancreatic remnant to reduce the pancreatic fistula rate

Dendritic cells loaded with U251 tumor cell antigen enhance the cytotoxic effect of cytokine-induced killer cells against U251 cell line / 中华神经医学杂志

Objective To study the cytotoxic effect of cytokine-induced killer cells (CIKs) cocultured with U251 tumor cell antigen-loaded mature dendritic cells (DCs) against U251 cell line. Methods The DCs and CIKs were derived from the cord blood mononuclear cells (CBMCs) of the same donor. The DCs were challenged with U251 tumor cell antigen, and cocultured with the CIKs to induce the cell complex Ag-DC-CIK. The mature DCs were identified by morphological and phenotypic analyses. MTT assay was performed to detect the cytotoxic effects ofCBMCs, CIKs, antigen-loaded CIKs (Ag-CIK) or the cell complex Ag-DC-CIK in U25 ! cells. Results The mature DCs derived from the CBMCs highly expressed the costimulatory molecules CD86 (82.66%) and CD40 (69.40%), and moderately expressed CD83 (57.49%) and CD80 (51.14%). The cytotoxic activity of the cell complex Ag-DC-CIK against U251 cells (58.8%) was significantly higher than those of CBMCs (29.71%), CIKs (39.89%), and Ag-CIK (49.92%). Statistical analysis indicated significant difference in the cytotoxic activity between any two of the groups (P<0.05). Conclusion The DCs loaded with the tumor cell antigen can enhance the cytotoxic effect of the CIKs against the target tumor cells, which sheds light on a new approach of immunotherapy for intracranial tumors.