High serum CA19–9 preoperatively reduces POPF risk after pancreatoduodenectomy in PDAC

Abstract

Background: Recent groundbreaking work revealed CA19–9 is not only a tumor marker for PDAC. It also induces severe pancreatitis and promotes pancreatic fibrosis. The aim of this study was evaluation if due fibrosis CA19–9 may stratify for reduced postoperative pancreatic fistula (POPF) risk. Material and Methods: Retrospective analysis of our institutional database of 954 consecutive patients having undergone PD between 2001 and 2018. Potential risk factors for POPF were evaluated. 436 (46%) patients with pancreatic ductal adenocarcinoma (PDAC) were analysed separately. POPF rate, degree of pancreatic fibrosis, inflammation and acinar cell area at the cut edge of pancreas (CEP) were investigated in correlation of CA19–9. Results: The median age was 67 (range 9–89) years. 533 (56%) were male, 22% of patients developed clinically relevant POPF (CR-POPF). Overall postoperative mortality was 3.4%. Elevated preoperative CA19–9, elevated bilirubin and postoperative low serum amylase were significantly (p<0.01) associated with a reduced POPF rate in patients with PDAC. In addition, elevated CA19–9 was significantly associated with more pancreatic fibrosis (p<0.02), inflammation (p<0.01) and acinar atrophy (p<0.01). Conclusion: In our experience, increased CA19–9 correlates with pancreatic fibrosis and reduced CR-POPF. CA19–9 could be complementary for preoperative POPF-scores.

Keywords

• Abbreviations: CR-POPF, Clinically relevant postoperative pancreatic fistula
• PDAC, Pancreatic ductal adenocarcinoma
• POPF, Postoperative pancreatic fistula