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Single-layer versus duct-to-mucosa pancreaticojejunostomy in pyloruspreserving pancreatoduodenectomy for ductal adenocarcinoma—an analysis of a single surgeon’s series

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Summary

Background

Despite considerable efforts there is no consensus regarding the ideal reconstruction method for the pancreatic remnant after pancreaticoduodenectomy (PD).

Methods

Overall, 86 patients who underwent PD for ductal adenocarcinoma were selected for analysis. One surgeon (RF) took responsibility of all pancreatic resections, either by operating personally or proctoring the procedure. The database was prospectively maintained. End-to-side pancreaticojejunostomy (PJ; Group A) was performed from 01/01 to 10/07 and duct-to-mucosa PJ (Group B) from 10/07 to 12/12. Primary endpoints were 30-day mortality, incidence of pancreatic fistulas, and severe complications. Secondary endpoints were severity of pancreatic fistulas, incidence of unplanned reoperation and reintervention and length of stay (LOS).

Results

30-day mortality, pancreatic fistula, complication, unplanned reoperation and reintervention rates showed no significant differences (2.2 vs. 2.4 %; 6.7 vs. 0 %; 22.2 vs. 29.3 %; 6.7 vs. 0 %; 11.1 vs. 2.2 %). Summarizing unplanned reoperations and reinterventions, the necessity of any unplanned procedure revealed, a significant reduction from 8 (17.8 %) in Group A to 1 (2.2 %) in Group B (p = 0.02). Major complications (Dindo–Clavien Grades III–V) were decreased significantly in Group B (Group A: 9/45 (20 %) vs. Group A: 2/41 (4.9 %); p = 0.05). LOS was significantly shorter in Group B (15 days, +/− 6.01) as compared with Group A (18 days, +/− 8.87; p < 0.05).

Conclusions

Our data show superior outcomes with duct-to-mucosa PJ as compared with single-layer PJ.

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References

  1. Birkmeyer JD, Siewers AD, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.

    Article  PubMed  Google Scholar 

  2. Gooiker GA, Lemmens VE, Besselink MG, et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg. 2014;101(8):1000–5.

    Article  CAS  PubMed  Google Scholar 

  3. McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy. A national perspective. Ann Surg. 2007;246:246–53.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–210.

    Article  PubMed  Google Scholar 

  5. Trede M, Schwall G. The complications of pancreatectomy. Ann Surg. 1988;207(1):39–47.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Fuks D, Piessen G, Huet E, et al. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy; incidence, prognosis, and risk factors. Am J Surg. 2009;197:702–9.

    Article  PubMed  Google Scholar 

  7. Fernández-Cruz L, Belli A, Acosta M, et al. Which is the best technique for pancreaticoenteric reconstruction after pancreaticoduodenectomy? A critical analysis. Surg Today. 2011;41(6):761–6.

    Article  PubMed  Google Scholar 

  8. Duffas JP, Suc B, Msika S, et al. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg. 2005;189(6):720–9.

    Article  PubMed  Google Scholar 

  9. Bassi C, Falconi M, Molinari E, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery. 2003;134(5):766–71.

    Article  PubMed  Google Scholar 

  10. Berger AC, Howard TJ, Kennedy EP, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg. 2009;208(5):738–47.

    Article  PubMed  Google Scholar 

  11. Langrehr JM, Bahra M, Jacob D, et al. Prospective randomized comparison between a new mattress technique and Cattell (duct-to-mucosa) pancreaticojejunostomy for pancreatic resection. World J Surg. 2005;29(9):1111–19.

    Article  PubMed  Google Scholar 

  12. Chou FF, Sheen-Chen SM, Chen YS, et al. Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. Eur J Surg. 1996;162(6):477–81.

    CAS  PubMed  Google Scholar 

  13. Shrikhande SV, Barreto G, Shukla PJ. Pancreatic fistula after pancreaticoduodenectomy: the impact of a standardized technique of pancreaticojejunostomy. Langenbecks Arch Surg. 2008;393(1):87–91.

    Article  PubMed  Google Scholar 

  14. Sarr MG; The Pancreatic Surgery Group. The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatoduodenectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg. 2003;196:556–64.

    Article  PubMed  Google Scholar 

  15. Bassi C, Dervenis CH, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  16. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5.

    Article  PubMed  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226(3):248–57.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Yang SH, Dou KF, Sharma N, et al. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. World J Surg. 2011;35:2290–7.

    Article  PubMed  Google Scholar 

  20. Kennedy EP, Yeo Ch. Dunking pancreaticojejunostomy versus duct-to-mucosa anastomosis. J Hepatobiliary Pancreat Sci. 2011;18:769–74.

    Article  PubMed  Google Scholar 

  21. Bai X, Zhang Q, Noman M, et al. Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis. Chin Med J. (2013);126(22):4340–47.

    PubMed  Google Scholar 

  22. Gangl O, Fröschl U, Hofer W, et al. Unplanned reoperation and reintervention after pancreatic resections: an analysis of risk factors. World J Surg. 2011;35:2306–14.

    Article  PubMed  Google Scholar 

  23. Gangl O, Sahora K, Kornprat P, et al. Preparing for prospective clinical trials: a national initiative of an excellence registry for consecutive pancreatic cancer resections. World J Surg. 2014;38(2):456–62.

    Article  PubMed  Google Scholar 

  24. Wamser P, Stift A, Passler C, et al. How to pass on expertise: pancreatoduodenectomy at a teaching hospital. World J Surg. 2002;26(12):1458–62.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Elisabethinen Hospital, Fadingerstrasse 1, 4020, Linz, Austria

    O. Gangl, U. Fröschl, R. M. Langer & R. Függer

Authors
  1. O. Gangl
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  2. U. Fröschl
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  3. R. M. Langer
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  4. R. Függer
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Corresponding author

Correspondence to O. Gangl.

Additional information

Single-layer versus duct-to–mucosa PJ in PD for DAC

The paper has been presented at the Austrian Society of Surgery 2015

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Gangl, O., Fröschl, U., Langer, R.M. et al. Single-layer versus duct-to-mucosa pancreaticojejunostomy in pyloruspreserving pancreatoduodenectomy for ductal adenocarcinoma—an analysis of a single surgeon’s series. Eur Surg 48, 34–38 (2016). https://doi.org/10.1007/s10353-015-0373-1

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  • DOI: https://doi.org/10.1007/s10353-015-0373-1

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