Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastroenterol. Apr 28, 2026; 32(16): 116238
Published online Apr 28, 2026. doi: 10.3748/wjg.v32.i16.116238
Published online Apr 28, 2026. doi: 10.3748/wjg.v32.i16.116238
Plasma apolipoprotein A2 isoforms predict the development of pancreatic fistula following distal pancreatectomy
Takashi Ono, Akira Matsushita, Daigo Yoshimori, Akira Hamaguchi, Takahiro Murokawa, Junji Ueda, Tetsuya Shimizu, Yoichi Kawano, Hiroshi Yoshida, Department of Gastroenterological Surgery, Nippon Medical School, Bunkyo-ku 113-8603, Tokyo, Japan
Mampei Kawashima, Yoshiharu Nakamura, Department of Gastroenterological Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai 270-1694, Chiba, Japan
Kengo Nagashima, Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku 160-8582, Tokyo, Japan
Ayumi Kashiro, Kazufumi Honda, Department of Molecular Prevention, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku 113-8602, Tokyo, Japan
Ayumi Kashiro, Kazufumi Honda, Department of Molecular Prevention, Institute for Advanced Medical Sciences, Nippon Medical School, Bunkyo-ku 113-8602, Tokyo, Japan
Author contributions: Ono T, Matsushita A, Honda K, and Yoshida H conceptualized and designed the study; Matsushita A, Honda K, Nakamura Y, and Yoshida H provided administrative support; Ono T, Matsushita A, Kawano Y, Nakamura Y, and Yoshida H provided the study materials or patients; Ono T, Matsushita A, Hamaguchi A, Yoshimori D, Murokawa T, Ueda J, Shimizu T, Kawashima M, and Kashiro A collected and assembled the data; Ono T, Matsushita A, Nagashima K, and Honda K analyzed and interpreted the data; all authors contributed to the writing and revision of the manuscript, and approved the final version of the manuscript to be published.
Supported by Scientific Research from the Japan Society for the Promotion of Science, No. 23K08141; Japan Agency for Medical Research and Development, No. 25ama221431h0002; and Agency for Medical Research and Development Practical Research for Innovative Cancer Control, No. 25ck0106922h0002.
Institutional review board statement: The Institutional Review Board of Nippon Medical School provided approval for this study, No. A-2020-044.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: Akira Matsushita, MD, PhD, Department of Gastroenterological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku 113-8603, Tokyo, Japan.
Received: November 6, 2025
Revised: December 18, 2025
Accepted: February 4, 2026
Published online: April 28, 2026
Processing time: 162 Days and 14.6 Hours
Revised: December 18, 2025
Accepted: February 4, 2026
Published online: April 28, 2026
Processing time: 162 Days and 14.6 Hours
Core Tip
Core Tip: Postoperative pancreatic fistula (POPF) is a major complication after distal pancreatectomy. This retrospective cohort study of 51 patients investigated the association between POPF and preoperative plasma apolipoprotein A2 isoforms, as a marker of pancreatic exocrine function. Patients with POPF had significantly higher apoA2-AT/AT levels than those without. Receiver operating characteristic analysis yielded an area under the curve of 0.802, with optimal cutoff value of 58.17 μg/mL calculated by Youden’s index. Levels above this threshold were independently associated with POPF. Thus, preoperative apolipoprotein A2 isoforms levels may help predict POPF risk, enabling better perioperative planning and personalized care for patients undergoing distal pancreatectomy.