Pancreaticoduodenectomy Procedure Research Articles

Mortality Rate of Oncological Patients Undergoing Pancreaticoduodenectomy Procedure in Brazil From 2021 to 2023: A Cross-Sectional Study

Mortality Rate of Oncological Patients Undergoing Pancreaticoduodenectomy Procedure in Brazil From 2021 to 2023: A Cross-Sectional Study

Relation between Preoperative vitamin D level and Post operative Infection in Patient undergoing Pancreaticoduodenectomy (Whipple’s) procedure

Relation between Preoperative vitamin D level and Post operative Infection in Patient undergoing Pancreaticoduodenectomy (Whipple’s) procedure

Need for a paradigm shift? Survival post-pancreatoduodenectomy remains poor despite surgical and oncological advances

Background: Despite advances in surgical techniques and chemotherapy, poor outcomes persist in pancreatic malignancy. This study aimed to investigate clinical outcomes and describe the impact of factors like the closest resection margin on overall survival following open pancreatoduodenectomy at a tertiary referral centre over a ten-year period. Methods: Patients who underwent a pancreaticoduodenectomy at a tertiary hospital in South Australia between 2009-2019 were included in this retrospective study. Patient demographics, systemic treatments, complications, and histological features were analysed for their role in overall survival. Kaplan-Meier survival curves were used to assess patient survival and estimate median survival time. Results: There were 134 open pancreaticoduodenectomy procedures during 2009-2019. Majority of patients were male (54.7%) between 65-75 years of age (41%) with an ASA physical status classification grade of 3 (63.3%). 56.7% of patients experienced a complication with 5 in-hospital deaths recorded and 12 ISPGF grade B or C pancreatic anastomotic leaks (n=5, n=7 respectively). 88% of resected specimens were malignant with an overall 5-year survival of 32%. A resection margin of >2 mm had a significantly improved overall survival compared to 0 mm (p=0.01). There was no survival benefit for a resection margin of <1 mm or 1-2 mm compared 0mm margin (p=0.6 and p=0.2 respectively). 65 patients (54.6%) experienced either local or distal disease recurrence by the end of the study period. Conclusions: There has been no improvement in overall survival post pancreatoduodenectomy for pancreatic malignancy. Further research into the clinical significance of the R status classification is required.

Superior mesenteric artery-first pancreaticoduodenectomy procedure: our experience within a tertiary academic centre

Superior mesenteric artery-first pancreaticoduodenectomy procedure: our experience within a tertiary academic centre

Safety and Hazards of Middle-Life Robotic Pancreaticoduodenectomy

Pancreaticoduodenectomy procedures early done in young individuals, few days about the risk and survival after robotic pancreaticoduodenectomy. Our goal was to report the results of robotic pancreaticoduenectomy in patients older than 50.

Selective extended dissection for pancreaticoduodenectomy is associated with better survival in pancreatic cancer patients: retrospective cohort study.

Pancreatic ductal adenocarcinoma is a highly malignant tumor with relatively poor survival. Surgery is the first choice for treating patients with early pancreatic cancer. However, the surgical approach and the extent of resection for patients with pancreatic cancer are currently controversial. The authors optimized the procedure of standard pancreaticoduodenectomy to selective extended dissection (SED), which is based on the extrapancreatic nerve plexus potentially invaded by the tumor. The authors retrospectively analyzed the clinicopathological data of patients with pancreatic adenocarcinoma who underwent radical surgery in our center from 2011 to 2020. Patients who underwent standard dissection (SD) were matched 2:1 to those who underwent SED using propensity score matching. The log-rank test and Cox regression model were used to analyze survival data. In addition, statistical analyses were performed for the perioperative complications, postoperative pathology, and recurrence pattern. A total of 520 patients were included in the analysis. Among patients with extrapancreatic perineural invasion (EPNI), disease-free survival was significantly longer in those who received SED than in those who received SD (14.5 months vs. 10 months, P <0.05). The incidence of metastasis in No. 9 and No. 14 lymph nodes was significantly higher in patients with EPNI. In addition, there was no significant difference in the incidence rate of perioperative complications between the two surgical procedures. Compared with SD, SED exhibits a significant prognostic benefit for patients with EPNI. The SED procedure aiming at specific nerve plexus dissection displayed particular efficacy and safety in resectable pancreatic ductal adenocarcinoma patients.

Pancreaticoduodenectomy with celiac artery resection (PD-CAR) for unresctable locally advanced pancreatic ductal adenocarcinoma

Locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) involving the celiac artery (CeA), the common hepatic artery and the gastroduodenal artery (GDA) is considered unresectable. We developed the novel procedure of pancreaticoduodenectomy with celiac artery resection (PD-CAR) for such LA-PDACs. From 2015 to 2018, we performed curative pancreatectomy with major arterial resection for 13 LA-PDACs as a clinical study (UMIN000029501). Of those, four patients with pancreatic neck cancer involving the CeA and GDA were candidates for PD-CAR. Prior to surgery, blood flow alterations were performed to unify the blood flow to the liver, stomach, and pancreas, resulting in feeding from the cancer-free artery. During PD-CAR, arterial reconstruction of the unified artery was performed as needed. Based on the records of PD-CAR cases, we retrospectively analyzed the validity of the operation. R0 resection was achieved in all patients. Arterial reconstruction was performed in three patients. In another patient, the hepatic arterial flow was maintained by preserving of the left gastric artery. The mean operative time was 669min, and the mean blood loss was 1003ml. Although Clavien-Dindo classification III-IV postoperative morbidities occurred in three patients, no reoperations nor mortalities occurred. Although two patients died of cancer recurrence, one patient survived for 26months without recurrence (died of cerebral infarction), and another is alive at 76months without recurrence. PD-CAR, which enabled R0 resection and preservation of the residual stomach, pancreas, and spleen, provided acceptable postoperative outcomes.

Venöz rezeksiyonlu pankreatikoduodenektomi sonuçları: 11 olgu ile tek merkez deneyimi

Aim: To perform a retrospective evaluation of the morbidity and mortality rates and reliability of venous resection with pancreaticoduodenectomy (PD) procedures in our clinic.&#x0D; Material and Method: The records of 11 patients who underwent PD with venous resection between May 2016 and May 2021 in the Eskişehir Osmangazi University Faculty of Medicine Department of General Surgery were analyzed retrospectively.&#x0D; Results: Eleven patients (five women and six men) were included. The patients’ mean age was 64.09±9.27 years (range 47-78). Four (36.36%) patients underwent type 1 reconstruction, one (9.09%) type 2 reconstruction, five (45.45%) type 3 reconstruction and one (9.09%) type 4 reconstruction. Eight (72.73%) patients experienced venous invasion according to the histopathology reports. Mean time between diagnosis and surgery was 14.91±11.33 days, and the mean follow-up time was 17.64±13.31 months. Grade C pancreatic fistula was observed in one (9.09%) patient, who died on the 17th postoperative day. No patients experienced recurrence or metastasis during surveillance.&#x0D; Conclusion: Pancreaticoduodenectomy with venous resection-reconstruction is safe and the only curative option in patients with pancreatic cancer and venous invasion.

Pancreatico-duodenectomy in a blunt trauma abdomen: a rare case report

Abdominal trauma, a very common occurrence, especially in a country like India with an abundance of road traffic accidents. However, very few of such patients present with pancreatic or duodenal injury. At times such an injury requires the complex and intricate procedure of pancreatico-duodenectomy. Such a procedure requires highly trained surgeons as well as extensive post operative monitoring. In the scenario that these are available, this major surgery becomes a lifesaving procedure. This case report describes one such successful outcome. Early presentation to the hospital, the availability of skilled surgeons and a good tertiary care set up have made the once rarely performed surgery called Whipple’s procedure (pancreatico-duodenectomy) into a live saving surgery which can be used for abdominal trauma cases as well.

S1869 A Case of Biliary Intraepithelial Neoplasia of the Extrahepatic Bile Duct

Introduction: Biliary intraepithelial neoplasia (BilIN) is a relatively new diagnosis that refers to flat or micropapillary precursor lesions of the bile duct which can develop into adenocarcinomas. Herein, we present a case of an extrahepatic biliary intraepithelial neoplasia that was found during endoscopic retrograde cholangiopancreatography (ERCP). Case Description/Methods: 54-year-old male with a history of hypertension and tobacco abuse presented with sharp, right upper quadrant abdominal pain with intermittent nausea and vomiting of one month duration. On admission, he was hemodynamically stable, with normal labs including liver function tests. MRI/MRCP revealed intra- and extra-hepatic duct dilation up to 12 mm with no intraductal filling defect or stricture and a normal gallbladder. (Figure A).The patient underwent an EUS which revealed common bile duct dilation up to 12 mm with a hypoechoic lesion in the distal bile duct, just proximal to the ampulla (Figure B). Given the EUS findings, an ERCP was performed. Cholangiogram revealed diffuse dilation of the biliary tree with no obvious stricture or filling defect (Figure C). The biliary tree was swept, and nothing was found. Due to the suspicious lesion seen on the EUS we performed distal common bile duct brushing and biopsies. Histopathology revealed biliary intraepithelial neoplasia, grade 2 (Figure D). His pain was controlled and was discharged with plans for pancreaticoduodenectomy (Whipple’s) procedure. Discussion: BilIN refers to flat or micropapillary precursor lesions of the bile duct which can develop into adenocarcinomas. They are commonly found in liver samples of chronic biliary and liver diseases such as hepatolithiasis, primary sclerosing cholangitis, choledochal cyst, chronic hepatitis C, and alcoholic cirrhosis. However, they are rarely found in clinical practice since they are not easily accessible, nor do they usually cause bile duct obstruction. The natural course of BillN is not well understood and in 2017, diagnostic criteria were created for lesions found in the intrahepatic duct based on their cellular and structural atypia. Lesions in the extrahepatic duct do occur, however, very rarely. This case is unusual in that the BilIN caused symptoms suggestive of biliary obstruction with a dilated bile duct and because the BillN was found in the extrahepatic duct. The case highlights the importance of considering BilIN in biliary obstruction and perform biopsies to identify the lesions prior to development of malignancy.Figure 1.: (A) MRI T2 flare reveals intra- and extra-hepatic duct dilation up to 12 mm with no intraductal filling defect or stricture. (B) EUS reveals hypoechoic lesion in the distal bile duct, just proximal to the ampulla. (C) ERCP cholangiogram reveals diffuse dilation of the biliary tree with no obvious stricture or filling defect. (D) Hematoxylin and eosin stain reveals dysplastic biliary epithelium (flat architecture; enlarged, hyperchromatic nuclei with nucleoli and some pseudostratification, rare mitotic figures) consistent with BilIN grade 2.

Clinicopathological features of gastric cancer after pancreaticoduodenectomy: reporting of three institutional cases and review of the global literature.

Gastric cancer after pancreaticoduodenectomy was firstly reported in 1995, and the number of reports about this topic has increased in the past years. This review aimed to elucidate the clinicopathological features of this disease. Data for 32 cases were obtained using literature search, and three cases in our institution were added. Twenty cases were reported from Japan, and fifteen cases were from the Western countries (Germany: 1 case, France: 2 cases, USA: 12 cases). In Japanese and the Western cases, the most dominant indication for pancreaticoduodenectomy was distal bile duct cancer and pancreatic ductal adenocarcinoma, respectively. The most frequently applied procedure of pancreaticoduodenectomy was pylorus-preserving pancreatoduodenectomy with pancreaticogastrostomy and pancreaticoduodenectomy with pancreaticojejunostomy, respectively. The median length of time interval from pancreaticoduodenectomy to GC detection tended to be shorter in the Japanese cases (61.5months vs. 115months). Of all cases, thirteen (37.1%) patients with gastric cancer showed no abdominal symptoms, and eight were diagnosed at regular gastroscopy. Surgical gastrectomy was performed in 30 patients, and among them, concomitant pancreatectomy was performed in six patients. Four patients received reanastomosis of remnant pancreas using pancreaticojejunostomy. Twenty-two (73.3%) patients had undifferentiated carcinomas, and stage 1, 2, 3, and 4 cancer was identified in 14, six, six, and four patients, respectively. All eight patients who had received routine gastroscopy were T1N0M0 stage 1. Gastric cancers after pancreaticoduodenectomy including newly reported Japanese cases and our institutional cases were reviewed to make Japanese studies available to a broader scientific audience. Further investigation is necessary to elucidate the most important carcinogens among the various potential local and systemic factors.

What is the impact of zinc deficiency for pancreatectomies in patients with pancreatic ductal adenocarcinoma?

Backgroundand purpose: Zinc is an essential element for human health and plays an important role in metabolic, immunological and other biological processes. The present study was conducted to investigate the association between zinc deficiency (ZD) and the perioperative clinical course in patients with pancreatic ductal adenocarcinoma (PDAC). MethodsOf 216 patients with PDAC who underwent elective pancreatectomy between 2013 and 2017 at our institution, 206 patients with sufficient clinical data were retrospectively reviewed. The perioperative variables were compared and the risk factors associated with infectious complications were identified. ResultsZD was preoperatively present in 36 (17.5%) of 206 patients with PDAC. In the patients of the ZD group, a higher proportion of males, higher preoperative modified Glasgow prognostic scores, a higher neutrophil-to-lymphocyte ratio, and a higher occurrence of postoperative infectious complications after pancreatectomy were observed, compared to the non-ZD group. By a univariate analysis, three risk factors were significantly associated with infectious complications after pancreatectomy: ZD (vs non-ZD: p = 0.002), serum albumin <3.5 g/dl (vs ≥ 3.5 g/dl: p = 0.005), and the procedure of pancreaticoduodenectomy (vs others: p = 0.013). By multivariate logistic regression analysis, the occurrence of infectious complications was significantly associated with ZD (OR 3.430, 95%CI 1.570 to 7.490, p = 0.002) and the procedure of pancreaticoduodenectomy (OR 2.030, 95%CI 1.090 to 3.770, p = 0.025). ConclusionsThe current study newly demonstrated that ZD could serve as a preoperative predictor of infectious complications after pancreatectomies in the patients with PDAC.

The Effect of Increase in Clinical Experience on Morbidity and Mortality After Pancreaticoduodenectomy Surgery

&lt;b&gt; Introduction:&lt;/b&gt; Pancreaticoduodenectomy surgery is widely accepted and applied worldwide for periampullary tumors. Despite the decline in mortality rates from 40% to 3% with the advances in surgical technique, morbidity is still high (40–50%). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; We aimed to investigate the effect of increased clinical experience on the length of hospital stay, morbidity, mortality, and survival after pancreaticoduodenectomy. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Materials and methods:&lt;/b&gt; The files of patients who underwent pancreaticoduodenectomy in our hospital between January 2007 and January 2018 were retrospectively reviewed and divided into four groups by years. Demographics, body mass index (BMI, kg/m2), medical history, preoperative biliary drainage application, surgical technique, histopathological features, postoperative morbidity, mortality, and survival were investigated. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Results: &lt;/b&gt; There was no difference between the groups in terms of age, gender, comorbid disease, history of biliary drainage, surgical technique, and operation time (P &gt; 0.05). The rate of postoperative complications has decreased over the years (P = 0.01). According to the Clavien-Dindo scale, the complication severity decreased significantly over the years (P = 0.05). The overall survival of the patients increased by years (P = 0.03); the Early postoperative mortality rate decreased in the first month (&lt;30 days) (P = 0.04). &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Conclusion:&lt;/b&gt; With increased clinical experience, morbidity and mortality decrease, overall survival is prolonged after pancreaticoduodenectomy procedure.

Laparoscopic Pancreaticojejunostomy Anastamosis Using an Articulating Needle Holder.

Pancreaticojejunal anastomosis is a technically challenging stage of the pancreaticoduodenectomy procedure for even the most experienced surgeon. We illustrate a buttressed duct-to-mucosa anastomosis (modified Blumgart technique) during laparoscopic pancreaticoduodenectomy using an articulating needle holder (FlexDex) (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A299). While performing a minimally invasive pancreaticoduodenectomy, an articulating needle holder (FlexDex) is introduced through an 8 mm laparoscopic port and used to perform the duct-to-mucosa pancreaticojejunal anastomosis. Parenchymal buttressing using 3/0 double ended barbed suture (Stratafix) and pancreas duct to jejunum using 5/0 Prolene.Approval was obtained from the Office of Ethics and Research Governance at our institution. Consent was gained from the individual patient involved, to submit this intraoperative video for publication. Successful intraoperative pancreaticojejunal anastomosis was performed using the articulating needle holder (FlexDex). The patient recovered from the procedure without complication, with no postoperative pancreatic fistula. We demonstrate the feasibility of performing a laparoscopic pancreaticojejunal anastomosis using an articulating needle holder (FlexDex).

More is More? Total Pancreatectomy for Periampullary Cancer as an Alternative in Patients with High-Risk Pancreatic Anastomosis: A Propensity Score-Matched Analysis

BackgroundPostpancreatectomy morbidity remains significant even in high-volume centers and frequently results in delay or suspension of indicated adjuvant oncological treatment. This study investigated the short-term and long-term outcome after primary total pancreatectomy (PTP) and pylorus-preserving pancreaticoduodenectomy (PPPD) or Whipple procedure, with a special focus on administration of adjuvant therapy and oncological survival.MethodsPatients who underwent PTP or PPPD/Whipple for periampullary cancer between January 2008 and December 2017 were retrospectively analyzed. Propensity score-matched analysis was performed to compare perioperative and oncological outcomes. Correspondingly, cases of rescue completion pancreatectomy (RCP) were analyzed.ResultsIn total, 41 PTP and 343 PPPD/Whipple procedures were performed for periampullary cancer. After propensity score matching, morbidity (Clavien-Dindo classification (CDC) ≥ IIIa, 31.7% vs. 24.4%; p = 0.62) and mortality rates (7.3% vs. 2.4%, p = 0.36) were similar in PTP and PPPD/Whipple. Frequency of adjuvant treatment administration (76.5% vs. 78.4%; p = 0.87), overall survival (513 vs. 652 days; p = 0.47), and progression-free survival (456 vs. 454 days; p = 0.95) did not significantly differ. In turn, after RCP, morbidity (CDC ≥ IIIa, 85%) and mortality (40%) were high, and overall survival was poor (median 104 days). Indicated adjuvant therapy was not administered in 77%.ConclusionsIn periampullary cancers, PTP may provide surgical and oncological treatment outcomes comparable with pancreatic head resections and might save patients from RCP. Especially in selected cases with high-risk pancreatic anastomosis or preoperatively impaired glucose tolerance, PTP may provide a safe treatment alternative to pancreatic head resection.

Clinical application of "Double R" anastomosis technique in laparoscopic pancreaticoduodenectomy procedure.

Laparoscopic pancreaticoduodenectomy (LPD) is widely used as a treatment for periampullary tumors and pancreatic head tumors. However, postoperative pancreatic fistula (POPF), which significantly affects mortality and length of hospital stay of patients, remains one of the most common and serious complications following LPD. Though numerous technical modifications for pancreaticojejunostomy (PJ) have been proposed, POPF is still the “Achilles heel” of LPD.To reduce POPF rate and other postoperative complications following LPD by exploring the best approach to manage with the pancreatic remnant, a novel duct-to-mucosa anastomosis technique named Double Layer Running Suture (Double R) for the PJ was established. During 2018 and 2020, a totally 35 patients who underwent LPD with Double R were included, data on the total operative time, PJ duration, estimated blood loss, recovery of bowel function, postoperative complications, and length of hospital stay were collected and analyzed.The average duration of surgery was (380 ± 69) minutes. The mean time for performing PJ was (34 ± 5) minutes. The average estimated blood loss was (180 ± 155) mL. The overall POPF rate was 8.6% (3/35), including 8.6% (3/35) for the biochemical leak, 0% (0/35) for Grade B, and 0% (0/35) for Grade C. No patient suffered from biliary fistula, post-pancreatectomy hemorrhage, and intra-abdominal infection, the 30-day mortality was 0%.Double R anastomosis is potentially a safe, reliable, and rapid anastomosis with a low rate of POPF and post-pancreatectomy hemorrhage. It provides surgeons more options when performing LPD. However, its safety and effectiveness should be verified further by a larger prospective multicenter study.

Journey of a tertiary care hospital at Puducherry, India, into becoming a high-volume centre for pancreaticoduodenectomy - a decade of experience

Background: This study aims to study the outcomes of the Pancreaticoduodenectomy (PD) procedure- at the department of Surgery, JIPMER, Puducherry, which was in the early process of evolving into a high-volume centre for PDs in the last decade. Methods: Details of 147 patients who underwent PDs from 2010-2019, were collected retrospectively from the Medical Records Department from 2010-2017, and prospectively in the last 2 years. Independent perioperative variables were compared to outcome variables - morbidity and mortality rates, and analysed. Results: 29 patients underwent PDs in the first 5-year period, and 118 in the second, with mortality rates decreasing from 27.6% to 10.2% (P-0.029), and to 5.8% in the last year. Overall morbidities remained significantly high, with clinically relevant POPF, DGE and PPH to be 28.2%, 30.1% and 22.6% respectively. Ampullary adenocarcinoma was the commonest malignant tumour (63.3%). Factor significantly associated with perioperative mortality were - the period of surgery (1st vs 2nd 5 year period), ASA scores, Bilirubin levels, Intraop blood loss, CR-POPF, PPH, pneumonia and Sepsis. But variables which significantly increased the risk of mortality by Multivariate Logistic regression were Sepsis (OR - 108.4, p-0.011), and post operative pulmonary complications. Median overall survival was 36 months (19 - 53) months. Conclusion: As we look back in the last decade, there have been significant improvement in the mortality rates of PD, but morbidity still remains high and has to be looked into as the department goes into a new decade as a young high volume centre.

Perioperative and oncological outcomes following minimally invasive versus open pancreaticoduodenectomy for pancreatic duct adenocarcinoma

BackgroundThe outcomes of minimally invasive pancreaticoduodenectomy have not been adequately compared with those of open pancreaticoduodenectomy in patients with pancreatic ductal adenocarcinoma. We performed a meta‐analysis to compare the perioperative and oncological outcomes of these two pancreaticoduodenectomy procedures specifically in patients with pancreatic ductal adenocarcinoma.MethodsBefore this study was initiated, a specific protocol was designed and has been registered in PROSEPRO (ID: CRD42020149438). Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, PubMed, EMBASE, Web of Science, Cochrane Central Register, and ClinicalTrials.gov databases were systematically searched for studies published between January 1994 and October 2019. Overall survival, disease-free survival, and time to commencing adjuvant chemotherapy were the primary endpoint measurements, whereas perioperative and short-term outcomes were the secondary endpoints.ResultsThe final analysis included 9 retrospective cohorts comprising 11,242 patients (1377 who underwent minimally invasive pancreaticoduodenectomy and 9865 who underwent open pancreaticoduodenectomy). There were no significant differences in the patients’ overall survival, operative time, postoperative complications, 30-day mortality, rate of vein resection, number of harvested lymph nodes, or rate of positive lymph nodes between the two approaches. However, disease-free survival, time to starting adjuvant chemotherapy, length of hospital stay, and rate of negative margins in patients who underwent minimally invasive pancreaticoduodenectomy showed improvements relative to those in patients who underwent open surgery.ConclusionsMinimally invasive pancreaticoduodenectomy provides similar or even improved perioperative, short-term, and long-term oncological outcomes when compared with open pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma.

Incidental hepatic tuberculosis during planned resection of locally advanced ampullary carcinoma: a case report

BackgroundTuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems.Case presentationA 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB.ConclusionsA high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.

Effect of Anastomosis Technique on Pancreatic Fistula Formation in Proximal Pancreaticoduodenectomy.

To find out the association between the pancreatic fistula development and the pancreaticoduodenectomy anastomosis technique performed in three different ways; namely, telescopic pancreatojejunostomy (PJ), ducto-mucosal Wirsungo jejunostomy (WJ), and Peng's variant of the telescopic technique. A descriptive study. Izmir Katip Celebi Universitesi Hospital, Turkey, from January 2011 to January 2018. A total of 144 proximal pancreaticoduodenectomy procedures were performed at the study centre. Patients' data was obtained from the outpatient files and hospital information system, retrospectively; and divided into three groups according to the pancreatic anastomosis techniques. All three groups were compared in terms of eight parameters. Preoperative parameters were age, gender, and serum direct bilirubin values; whereas, postoperative parameters were pathology, pancreatic fistula, drain amylase, serum albumin value and early mortality. All variables by anastomosis type belonging to three groups differed for fistula rates (p=0.384), pathology types (p=0.142), preoperative bilirubin (p=0.631) and postoperative albumin (p=0.516) levels, early mortality (p=0.242) parameters without reaching statistical significance (p>0.05); however, the low anastomosis leak rates in Peng's technique were remarkable. POPF (post-operative pancreatic fistula) developed in 34% patients under 60 years vs. 17.6% patients over 60 years of age (p=0.029); and 13.7% females vs. 29.9% of male patients (p=0.032). No factors other than age and gender were found to be significant alone in the development of pancreatic fistula after proximal pancreaticoduodenectomy. Key Words: Postoperative pancreatic fistula, Pancreaticoduodenectomy, Pancreatojejunostomy, Telescopic pancreatojejunostomy (PJ), Ducto-mucosal Wirsungo jejunostomy (WJ), Peng's telescopic technique.