Clinical evaluation of modified invaginated pancreaticojejunostomy for pancreaticoduodenectomy

Dong Wang,Zhongtao Zhang,Wei Guo,Xiao Liu,Kun Liu,Hongwei Wu,Xiaona Zhou,Jun Liu

doi:10.1186/s12957-020-01851-6

Abstract

BackgroundPancreaticoduodenectomy (PD) remains the major curative operation for malignant neoplasm of pancreas or cancerous tumors near the pancreas. Despite advancements in recent years, the postoperative recurrence rate of these neoplasms and tumors remains high. Moreover, overall morbidity remains high due to clinically relevant postoperative pancreatic fistula (POPF).MethodsTo compare the clinical outcomes of modified invaginated anastomosis and mucosa-to-mucosa anastomosis, this retrospective study included 343 patients who underwent PD from January 2008 to January 2019 at Beijing Friendship Hospital, Capital Medical University. The patients’ general conditions and disease status were preoperatively evaluated. The surgical procedure was recorded, and operative management was appropriately performed.ResultsCompared with mucosa-to-mucosa anastomosis, modified invaginated anastomosis resulted in a higher intraoperative blood transfusion rate (P < 0.001) and lower hospitalization expenses (P = 0.049). However, no significant differences were found in operation time (P = 0.790), intraoperative bleeding (P = 0.428), postoperative recovery exhaust time (P = 0.442), time to normal flow of food (P = 0.163), and hospitalization time (P = 0.567). Operation time was a risk factor for POPF (odds ratio 1.010; 95% confidence interval 1.003–1.016; P = 0.003). The incidence of pancreatic fistula (grades B and C) was lower in the patients who underwent modified invaginated anastomosis (14.1%) than in those who underwent mucosa-to-mucosa anastomosis (15.3%). The operation time was greater in the POPF group than in the non POPF group among the patients who received modified invaginated anastomosis (P = 0.003) and mucosa-to-mucosa anastomosis (P = 0.002).ConclusionModified invaginated pancreaticojejunostomy for PD resulted in a decreased incidence of POPF; it may serve as a new approach for PD while managing patients who have undergone PD.

Highlights

Surgical resection for periampullary diseases is an important treatment modality and primarily includes total pancreatectomy (TP) and pancreaticoduodenectomy (PD) [1]
Unlike TP, which results in the permanent insufficiency of pancreatic endocrine and exocrine function, PD is more feasible and still remains a major curative operation for malignant neoplasm of pancreas and cancerous tumors near the pancreas [2,3,4,5]
88 patients were diagnosed with a tumor or mass in the ampulla, and 111 patients were diagnosed with icterus

Summary

Introduction

Surgical resection for periampullary diseases is an important treatment modality and primarily includes total pancreatectomy (TP) and pancreaticoduodenectomy (PD) [1]. Unlike TP, which results in the permanent insufficiency of pancreatic endocrine and exocrine function, PD is more feasible and still remains a major curative operation for malignant neoplasm of pancreas and cancerous tumors near the pancreas [2,3,4,5]. Despite advancements in surgical procedures, interventional radiology, perioperative management, and anesthesia techniques in recent years, the postoperative recurrence rate of these neoplasms and tumors remains high at up to 40%, which is higher than that of other gastroenterological cancers [3, 9, 10]. Overall morbidity is still high due to clinically relevant postoperative pancreatic fistula (POPF) [11, 12]. Pancreaticoduodenectomy (PD) remains the major curative operation for malignant neoplasm of pancreas or cancerous tumors near the pancreas. Overall morbidity remains high due to clinically relevant postoperative pancreatic fistula (POPF)

Methods

Results

Conclusion