Abstract
BackgroundPostoperative pancreatic fistula (PF) is the main cause of operative mortality in patients who undergo pancreatoduodenectomy. Various pancreatoenteric anastomosis techniques have been reported to minimize the postoperative PF rate. However, the optimal method remains unknown. This study was performed to clarify the impact of pancreatojejunostomy on clinically relevant PF (CR-PF) between Blumgart anastomosis and Kakita anastomosis in patients with a soft pancreas.MethodsIn total, 620 consecutive patients underwent pancreatoduodenectomy at our institute from January 2010 to December 2016, and 282 patients with a soft pancreas were analyzed (Blumgart anastomosis, n = 110; Kakita anastomosis, n = 176). Short-term outcomes were assessed, and univariate and multivariate analyses of several clinicopathological variables were performed to analyze factors affecting the incidence of CR-PF.ResultsThe CR-PF rate was 42.7% (122/286). The CR-PF rate was not significantly different between the Blumgart and Kakita groups (42.7% and 42.6%, respectively; p = 0.985). The morbidity rate (Clavien–Dindo grade ≥ IIIa) was 24.5% (70/286), and the operation-related mortality rate was 0.7% (2/286). In the multivariate analysis, male sex (p = 0.0245) and a body mass index of ≥22 kg/m2 (p < 0.0001) were statistically significant risk factors for CR-PF.ConclusionsThe CR-PF rate was not significantly different between patients treated with Kakita versus Blumgart anastomosis.
Highlights
Postoperative pancreatic fistula (PF) is the main cause of operative mortality in patients who undergo pancreatoduodenectomy
To minimize the incidence of postoperative PF, which is closely associated with subsequent mortality, we have contrived various pancreatoenteric anastomosis techniques, and several methods of pancreatojejunostomy (PJ) have been proposed in the literature
Twelve patients (4.2%) developed Grade C PF; reoperation was required for 6 patients, and arterial embolization for intra-abdominal bleeding was required for 6 patients
Summary
Postoperative pancreatic fistula (PF) is the main cause of operative mortality in patients who undergo pancreatoduodenectomy. Various pancreatoenteric anastomosis techniques have been reported to minimize the postoperative PF rate. Recent advances in surgical techniques and perioperative management have made it possible to reduce the postoperative mortality rate after pancreatoduodenectomy. A nationwide survey from Japan reported that the mortality rate after pancreatoduodenectomy was 2.9% [1]. The recently reported mortality rate after pancreatoduodenectomy in the US was 1.4% [2]. Pancreatoduodenectomy remains a complex and technically demanding procedure, and postoperative pancreatic fistula (PF) is an unsolved. To minimize the incidence of postoperative PF, which is closely associated with subsequent mortality, we have contrived various pancreatoenteric anastomosis techniques, and several methods of pancreatojejunostomy (PJ) have been proposed in the literature.
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