Abstract
BackgroundThe mortality following pancreaticoduodenectomy has markedly decreased but remains an important challenge for the complexity of operation and technical skills involved. The present study aimed to clarify the impact of individualized pancreaticoenteric anastomosis and management to postoperative pancreatic fistula.MethodsData from 529 consecutive pancreaticoduodenectomies were retrospectively analysed from the Hepatobiliary and Pancreatic Surgery Unit I, Peking Cancer Hospital. The pancreaticoenteric anastomosis was determined based on the pancreatic texture and diameter of the main pancreatic duct. The amylase value of the drainage fluid was dynamically monitored postoperatively on days 3, 5 and 7. A low speed intermittent irrigation was performed in selected patients. Intraoperative and postoperative results were collected and compared between the pancreaticogastrostomy (PG) group and pancreaticojejunostomy (PJ) group.ResultsFrom 2010 to 2019, 529 consecutive patients underwent pancreaticoduodenectomy. Pancreaticogastrostomy was performed in 364 patients; pancreaticojejunostomy was performed in 150 patients respectively. The clinically relevant pancreatic fistula (CR-POPF) was 9.8% and mortality was zero. The soft pancreas, diameter of main pancreatic duct≤3 mm, BMI ≥ 25, operation time > 330 min and pancreaticogastrostomy was correlated with postoperative pancreatic fistula significantly. The CR-POPF of PJ was significantly higher than that of PG in soft pancreas patients; the operation time of PJ was shorter than that of PG significantly in hard pancreas patients. Intraoperative blood loss and operation time of PG was less than that of PJ significantly in normal pancreatic duct patients (p < 0.05).ConclusionsIndividualized pancreaticoenteric anastomosis should be determined based on the pancreatic texture and pancreatic duct diameter. The appropriate anastomosis and postoperative management could prevent mortality.
Highlights
The mortality following pancreaticoduodenectomy has markedly decreased but remains an important challenge for the complexity of operation and technical skills involved
There have been a number of reported managements to reduce the incidence of Postoperative pancreatic fistula (POPF)
PG was performed in patients with a normal main pancreatic duct (≤3 mm) and/or soft pancreas texture because the occurrence of clinically significant postoperative pancreatic fistula is more likely in such patients
Summary
The mortality following pancreaticoduodenectomy has markedly decreased but remains an important challenge for the complexity of operation and technical skills involved. The present study aimed to clarify the impact of individualized pancreaticoenteric anastomosis and management to postoperative pancreatic fistula. Despite a significant improvement in postoperative outcomes during recent decades, only a limited number of reports have documented zero mortality in consecutive pancreaticoduodenectomy series. Postoperative pancreatic fistula (POPF) is one of the most potentially fatal complication after PD with rate ranging from 40 to 70%, which might cause arterial bleeding and mortality rate to 11–60% [4,5,6]. The approach to management of the pancreatic remnant and form of pancreaticoenteric anastomosis (PA) determined the chance of developing POPF. The prompt management of POPF decreased mortality, included in prophylactic use of octreotide and antibiotics
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