Inflammation and fibrosis at pancreatic resection margin and their role in post-operative pancreatic fistula development after pancreaticoduodenectomy: a pilot study from a single institution

Background/objectives: Postoperative pancreatic fistula (POPF) is a major complication after pancreaticoduodenectomy (PD), with significant impact on outcomes. While the absence of pancreatic fibrosis is a known risk factor, its intraoperative assessment is often subjective. Moreover, the potential protective role of chronic inflammation at the pancreatic resection margin (PRM) has not been fully explored. This study aimed to evaluate the histological presence of fibrosis and chronic lymphomononuclear inflammatory infiltrate (CLII) at the PRM as predictors of POPF and clinically relevant POPF (CR-POPF), and to assess their intraoperative feasibility via frozen sections. Materials and methods: A retrospective analysis was performed on 141 patients who underwent PD (2014-2022). Intraoperative frozen sections of the PRM were reviewed for fibrosis and CLII using standardized semi-quantitative grading. Univariate and multivariate analyses identified predictors of POPF and CR-POPF. Results: = 0.0099). Combined absence of both further elevated risk (OR 5.20 for POPF; OR 4.83 for CR-POPF). In multivariate analysis, absence of fibrosis and CLII and main pancreatic duct