|
KMID : 1143920220260010084
|
|
Annals of Hepato-Biliary-Pancreatic Surgery
2022 Volume.26 No. 1 p.84 ~ p.90
|
|
|
What is the pancreatic duct size limit for a safe duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy? A retrospective study
|
|
Lee Kit-Fai
Wong Kandy Kam Cheung
Lo Eugene Yee Juen
Kung Janet Wui Cheung
Lok Hon-Ting
Chong Charing Ching Ning
Wong John
Lai Paul Bo San
Ng Kelvin Kwok Chai
|
|
|
Abstract
|
|
|
Backgrounds/Aims: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a dreadful complication. Duct-to-mucosa pancreaticojejunostomy (DTMPJ) is a commonly performed anastomosis after PD. This study aims to evaluate whether there is a size limit of pancreatic duct below which POPF rate increases significantly after DTMPJ.
Methods: A retrospective study was performed from a database with prospectively collected data on consecutive patients undergoing DTMPJ.
Results: Between the years 2003 and 2019, a total of 288 patients with DTMPJ were recruited. POPF occurred in 56.3% of the patients, of which 43.8% were biochemical leak, 8.7% were grade B, and 1.4% were grade C. Overall operative morbidity was 51.4%, of which 19.1% were major complications. Five patients (1.7%) died within 90 days of operation. Patients with grade B/C POPF had significantly soft pancreas (p < 0.001), smaller duct size (p = 0.031), and a diagnosis of carcinoma of the pancreas (p = 0.027). When a clinically significant POPF rate was analysed based on the pancreatic duct diameter, pancreatic duct size ≤ 1 mm had the highest POPF rate (35.7%). There was a significant difference in POPF rate between adjacent ductal diameter ≤ 1 mm and > 1 mm to 2 mm (35.7% vs 13.3%; p = 0.040). Multivariable analysis showed that for the soft pancreas, pancreatic duct diameter ≤ 1 mm was the only significant predictive factor for POPF (p = 0.027).
Conclusions: DTMPJ can be safely performed for pancreatic duct > 1 mm without significantly increased POPF risk.
|
|
|
KEYWORD
|
|
|
Pancreaticoduodenectomy, Pancreaticojejunostomy, Pancreatic fistula
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
 
|