Antecolic versus retrocolic reconstruction after partial pancreaticoduodenectomy

Hüttner, Felix J; Klotz, Rosa; Ulrich, Alexis; Büchler, Markus W.; Probst, Pascal

doi:10.1002/14651858.cd011862.pub3

Cited by 6 publications

(3 citation statements)

References 57 publications

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“…A recent Cochrane update concluded that the various gastrojejunal reconstructions do not affect the proportion of DGE [ 40 ]. Still, some believe DGE is related to the duodenojejunostomy after PPPD, and a recently published study has shown decreased rates of DGE with a novel technique for duodenojejunostomy which allows for future widening of the anastomosis [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Delayed Gastric Emptying After Pancreatoduodenectomy: A Swedish National Registry‐Based Study

Zdanowski,

Wennerblom,

Rystedt

et al. 2023

World j. surg.

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Background Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy (PD). DGE causes prolonged hospital stay and a decrease in quality of life. This study analyzes predictive factors for development of DGE after PD, also in the absence of surgical complications. Method Data from the Swedish National Pancreatic Cancer Registry for patients undergoing standard and pylorus preserving open PD from January 2010 until June 30, 2018, were collected. Data were analyzed in two groups, no DGE and DGE. A subgroup of patients with DGE but without surgical complications was compared to patients without DGE or any other surgical complication. Results In total, 2503 patients were included, of which 470 (19%) had DGE. In the DGE group, 238 had other coexisting surgical complications and 232 had not. Postoperative pancreatic fistula (OR = 4.22, p < 0.001), surgical infection (OR = 1.44, p = 0.013), heart disease (OR = 1.32, p = 0.023) and medical complications (OR = 1.35, p = 0.025) increased the risk for DGE. A standard PD compared with pylorus preserving resection (OR = 1.69, p = 0.001) and a reconstruction with a pancreaticojejunostomy compared with a pancreaticogastrostomy (OR = 1.83, p < 0.001) increased the risk. For patients without surgical complications, a standard PD and reconstruction with pancreaticojejunostomy still increased the risk for DGE. Conclusion DGE is more common after standard PD compared to pylorus preserving PD and after reconstruction with PJ compared to PG in this national cohort, both in the presence of other surgical complications as well as in the absence of other complications.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for Delayed Gastric Emptying After Pancreatoduodenectomy: A Swedish National Registry‐Based Study

Zdanowski,

Wennerblom,

Rystedt

et al. 2023

World j. surg.

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“…A Cochrane analysis published in 2022 establishes that there are no relevant differences between these two approaches. 23…”

Section: Anastomosesmentioning

confidence: 99%

Effects of Pancreatic Surgery : Quality of Life, Cost-effectiveness and Postoperative Results

Johansen

2023

Linköping University Medical Dissertations

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“…hemorrhage, intra-abdominal fluid collection, abscess, or reoperation rate) or mortality. 8 A study of 138 distal gastrectomy patients showed less delayed gastric emptying with antecolic reconstruction compared with retrocolic reconstruction; 9 however, there is a lack of large, population-based studies comparing postoperative complications after total or partial gastrectomy with antecolic versus retrocolic reconstruction for gastric cancer.…”

mentioning

confidence: 99%

Comparison of Postoperative Complications After Gastrectomy for Gastric Cancer with Antecolic Versus Retrocolic Reconstruction: A Population-Based Study

Junttila,

Helminen,

Helmiö

et al. 2024

Ann Surg Oncol

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Background The purpose of this study was to examine the rates of 90-day anastomotic complications and other postoperative complications after total or partial gastrectomy with antecolic versus retrocolic reconstruction in a population-based setting. Methods This population-based nationwide retrospective cohort study included all patients undergoing total or partial gastrectomy for gastric adenocarcinoma in Finland in 2005–2016, with follow-up until 31 December 2019. Logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs) of 90-day mortality. Results were adjusted for age, sex, year of the surgery, comorbidities, tumor locations, pathological stage, and neoadjuvant therapy. Results A total of 2063 patients having gastrectomy with antecolic (n = 814) or retrocolic (n = 1249) reconstruction were identified from the registries. The anastomotic complication rate was 3.8% with antecolic reconstruction and 5.0% with retrocolic reconstruction. Antecolic reconstruction was not associated with a higher risk of anastomotic complications compared with retrocolic reconstruction in the adjusted analysis (OR 0.69, 95% CI 0.44–1.09) of the whole cohort or in the predefined subgroups. The reoperation rate was 8.2% with antecolic reconstruction and 7.7% with retrocolic reconstruction, without statistical significance. In subgroup analysis of total gastrectomy patients, the risk of major complications was lower with antecolic reconstruction compared with retrocolic reconstruction (OR 0.62, 95% CI 0.45–0.86). Conclusions The rate of anastomotic complications did not differ after antecolic versus retrocolic reconstruction after total or partial gastrectomy. In total gastrectomies, the risk of major complications was lower after antecolic compared with retrocolic reconstruction.

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Antecolic versus retrocolic reconstruction after partial pancreaticoduodenectomy

Cited by 6 publications

References 57 publications

Predictive Factors for Delayed Gastric Emptying After Pancreatoduodenectomy: A Swedish National Registry‐Based Study

Predictive Factors for Delayed Gastric Emptying After Pancreatoduodenectomy: A Swedish National Registry‐Based Study

Effects of Pancreatic Surgery : Quality of Life, Cost-effectiveness and Postoperative Results

Comparison of Postoperative Complications After Gastrectomy for Gastric Cancer with Antecolic Versus Retrocolic Reconstruction: A Population-Based Study

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