Online citations, reference lists, and bibliographies.

Clinical And Experimental Studies Of Intraperitoneal Lipolysis And The Development Of Clinically Relevant Pancreatic Fistula After Pancreatic Surgery

Yuichiro Uchida, Takashi Masui, Keimei Nakano, Akitada Yogo, Aki Sato, Koichiro Nagai, Takayuki Anazawa, Kyoichi Takaori, Yasuhiko Tabata, Shinji Uemoto
Published 2019 · Medicine
Cite This
Download PDF
Analyze on Scholarcy
Share
BACKGROUND Visceral obesity is one of the risk factors for clinically relevant pancreatic fistula after pancreatic resection. The objective of this study was to evaluate the impact of intraperitoneal lipolysis on postoperative pancreatic fistula. METHODS The degree of intraperitoneal lipolysis was investigated by measuring the free fatty acid concentration in drain discharge in patients after pancreatic resection. An experimental pancreatic fistula model was prepared by pancreatic transection, and the impact of intraperitoneal lipolysis was evaluated by intraperitoneal administration of triolein (triglyceride) with, or without orlistat (lipase inhibitor). RESULTS Thirty-three patients were included in the analysis. The free fatty acid concentration in drain discharge on postoperative day 1 was significantly associated with the development of a clinically relevant pancreatic fistula (P = 0·004). A higher free fatty acid concentration in drain discharge was associated with more visceral adipose tissue (P = 0·009). In the experimental model that included 98 rats, intraperitoneal lipolysis caused an increased amount of pancreatic juice leakage and multiple organ dysfunction. Intraperitoneal administration of a lipase inhibitor reduced lipolysis and prevented deterioration of the fistula. CONCLUSION Intraperitoneal lipolysis significantly exacerbates pancreatic fistula after pancreatic resection. Inhibition of lipolysis by intraperitoneal administration of a lipase inhibitor could be a promising therapy to reduce clinically relevant postoperative pancreatic fistula. Surgical relevance Clinically, there are two types of pancreatic fistula after pancreatic resections: harmless biochemical leak and harmful clinically relevant pancreatic fistula. Visceral obesity is one of the known risk factors for clinically relevant pancreatic fistula; however, the underlying mechanisms remained to be elucidated. Patients with clinically relevant pancreatic fistula had a higher free fatty acid concentration in the drain discharge, suggesting a relationship between intraperitoneal lipolysis and pancreatic fistula. The experimental model of pancreatic fistula demonstrated that intraperitoneal lipolysis caused deterioration in pancreatic fistula, suggesting that intraperitoneal lipolysis is one of the mechanisms that drives biochemical leakage to clinically relevant pancreatic fistula. Intraperitoneal administration of a lipase inhibitor prevented lipolysis as well as pancreatic fistula deterioration in the experimental model, suggesting a future clinical application for lipase inhibitors in prevention of clinically relevant pancreatic fistula.
This paper references
10.1126/scitranslmed.3002573
Lipotoxicity Causes Multisystem Organ Failure and Exacerbates Acute Pancreatitis in Obesity
Sarah Navina (2011)
10.1097/SLA.0b013e318256c32c
Preoperative CT Scan Helps to Predict the Occurrence of Severe Pancreatic Fistula After Pancreaticoduodenectomy
Hadrien Tranchart (2012)
10.1002/bjs.9221
Body mass index and outcomes following gastrointestinal cancer surgery in Japan.
Hideo Yasunaga (2013)
10.1245/s10434-016-5385-y
Impact of Sarcopenic Obesity on Surgical Site Infection after Laparoscopic Total Gastrectomy
T. Nishigori (2016)
10.1038/sj.ki.5001629
Albumin-bound fatty acids induce mitochondrial oxidant stress and impair antioxidant responses in proximal tubular cells.
David A. Ishola (2006)
10.1016/j.pan.2016.06.011
Triple-drug therapy to prevent pancreatic fistula after pancreatectomy in a rat model.
Naoki Kuroshima (2016)
10.1245/s10434-017-6216-5
Impact of Sarcopenic Obesity on Failure to Rescue from Major Complications Following Pancreaticoduodenectomy for Cancer: Results from a Multicenter Study
Nicoló Pecorelli (2017)
10.1002/bjs.10316
Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery
Oliver Strobel (2017)
10.1007/s00595-016-1367-8
Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy
Yoshihiro Miyasaka (2016)
10.1159/000354357
Role of p66shc in Renal Toxicity of Oleic Acid
Istvan Arany (2013)
10.1046/j.1365-2168.2001.01659.x
Somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of enterocutaneous pancreatic fistulas: a systematic review of randomized controlled trials.
J. Li-ling (2001)
10.1016/j.joca.2012.02.010
Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research.
Carol Kilkenny (2012)
10.1016/0016-5085(95)90158-2
Interleukin 10 prevents necrosis in murine experimental acute pancreatitis.
Jean-Luc van Laethem (1995)
10.1016/j.jcrc.2014.06.003
Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: effects of shock and treatment.
I. Ilias (2014)
10.1002/bjs.10063
Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery.
Nicoló Pecorelli (2016)
10.1007/s00535-012-0706-9
Development of a novel rat model with pancreatic fistula and the prevention of this complication using tissue-engineered myoblast sheets
Takayuki Tanaka (2012)
10.1097/MD.0000000000006858
Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)
Sergio Pedrazzoli (2017)
10.1016/0378-4347(87)80507-8
High-performance liquid chromatographic analysis of serum long-chain fatty acids by direct derivatization method.
H. Miwa (1987)
10.3109/14017431.2010.491553
Hazards with electrocautery-induced decomposition of fatty acids – in view of lipid embolization
Karin Engström (2010)
10.1002/ca.20543
Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes
Y. Saisho (2007)
10.1016/j.ijsu.2017.04.058
Impact of obesity on short and long term results following a pancreatico-duodenectomy.
Awad Shamali (2017)
10.1016/j.surg.2016.12.022
Novel therapy for pancreatic fistula using adipose‐derived stem cell sheets treated with mannose
Hirokazu Kaneko (2017)
10.1016/0014-5793(91)80997-H
Lipoprotein lipases and vitellogenins in relation to the known three-dimensional structure of pancreatic lipase.
B C Persson (1991)
10.6092/1590-8577/376
An immunocytochemical profile of the endocrine pancreas using an occlusive duct ligation model.
Benedict John Page (2000)
10.1016/j.plipres.2008.03.003
Fatty acid composition of adipose tissue and blood in humans and its use as a biomarker of dietary intake.
Leanne Hodson (2008)
10.1016/j.ajpath.2014.11.019
Lipolysis of visceral adipocyte triglyceride by pancreatic lipases converts mild acute pancreatitis to severe pancreatitis independent of necrosis and inflammation.
Krutika Patel (2015)
10.1007/s00423-018-1668-z
Computer tomographic assessment of postoperative peripancreatic collections after distal pancreatectomy
Yuichiro Uchida (2018)
10.1016/j.surg.2016.05.046
Impact of obesity on surgical outcomes of laparoscopic distal pancreatectomy: A Norwegian single-center study.
M. Sahakyan (2016)
10.1056/NEJMoa1313688
Pasireotide for postoperative pancreatic fistula.
Peter J. Allen (2014)
Intraperitoneal lipolysis and postoperative pancreatic fistula 625 on failure to rescue from major complications following pancreaticoduodenectomy for cancer : results from a multicenter study
H Tranchart
10.1016/j.metabol.2012.12.001
Fatty acid-mediated endoplasmic reticulum stress in vivo: differential response to the infusion of Soybean and Lard Oil in rats.
Angela M Nivala (2013)
10.1016/j.pan.2017.03.007
Abdominal contamination with Candida albicans after pancreaticoduodenectomy is related to hemorrhage associated with pancreatic fistulas.
Asahi Sato (2017)
10.1016/j.surg.2016.11.014
The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After
Claudio Bassi (2017)
10.1136/gutjnl-2014-308043
Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections
Pawan Noel (2014)



This paper is referenced by
Semantic Scholar Logo Some data provided by SemanticScholar