ArticleGland surgery2026
Clinical, microbial, and experimental features associated with Grade C postoperative pancreatic fistula and pancreaticojejunostomy disruption.
Article in Gland surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
Background: Most postoperative pancreatic leaks after pancreatoduodenectomy (PD) remain clinically insignificant biochemical leaks, whereas a minority progress to life-threatening Grade C postoperative pancreatic fistula (POPF). The biological events underlying this progression remain poorly understood. We investigated the clinical, microbial, and immunological mechanisms associated with severe POPF progression. Methods: Of 642 consecutive patients assessed between March 2022 and March 2024, 74 were excluded and 568 were included in the clinical cohort. Risk factors for Grade C POPF were evaluated using univariable analysis and Firth penalized multivariable logistic regression. For translational analyses, peritoneal fluid from 20 patients with biochemical leak and 20 patients with Grade C POPF underwent 16S ribosomal RNA (rRNA) sequencing and multiplex cytokine profiling. Human pancreatic tissues from two Grade C POPF patients and three histologically normal controls were evaluated descriptively. Experimental evaluation used a rat model combining pancreatic and intestinal fistulas to simulate enteric contamination relevant to pancreaticojejunostomy leakage. Results: Among 568 included patients, 20 (3.5%) developed Grade C POPF. Pancreaticojejunostomy disruption occurred in 13 of 20 Grade C patients and 17 of 548 non-Grade C patients (65.0% Conclusions: Grade C POPF was strongly associated with pancreaticojejunostomy disruption and was accompanied by peritoneal microbial and inflammatory differences compared with biochemical leak. The animal model simulated key features of pancreaticojejunostomy leakage and supports the possibility that enteric contamination contributes to inflammatory aggravation.
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