High Values of Drain Fluid Epidermal Growth Factor and Transforming Growth Factor-beta are Associated with the Development of Pancreatic Fistula after Pancreatoduodenectomy

Introduction: Postoperative inflammatory response may act as a major determinant of anastomotic failure after pancreaticoduodenectomy. In this pilot study, we investigated the potential role of drain fluid cytokines in predicting postoperative pancreatic fistula (POPF). Methods Drain fluid TGF-β, IGF-1, EGF and IL-6, together with serum amylase and drain fluid amylase were measured on POD1 and correlated to the development of POPF. Results The study population consisted of 66 patients. POPF and Clavien-Dindo 3 morbidity rates were 12.1% and 9.1%, respectively. Patients developing POPF presented significantly higher values of POD1 serum amylase level (477 vs 54UI/L, p< 0.001), drain fluid amylase (7500 vs. 127UI/L, p< 0.001), TGF (94 vs. 40pg/g, p= 0.045) and EGF (17 vs. 13, p= 0.015). There were no differences in terms of IGF-1 and IL-6 values. Conclusion Assessing the local inflammatory response after pancreatoduodenectomy could represent a promising field of research since both TGF and EGF seem to be associated with the occurrence of POPF.