Leakage of an Invagination Pancreaticojejunostomy May Have an Influence on Mortality

Abstract

Purpose: No consensus exists regarding the most effective form of pancreaticojejunostomy (PJ) following pancreaticoduodenectomy (PD). Methods: Data were gathered through the American College of Surgeons-National Surgical Quality Improvement Program, Pancreatectomy Demonstration Project. A total of 1781 patients underwent a PD at 43 institutions. After appropriate exclusions, 890 patients were analyzed. Patients were divided into duct-to-mucosa (n = 734, 82%) and invagination (n = 156, 18%) groups and were compared by unadjusted analysis. Type of PJ was included in eight separate morbidity and mortality multivariable analyses. Results: Invagination patients had higher serum albumin ( p < 0.01) and lower body mass index ( p < 0.01), were less likely to have a preoperative biliary stent ( p < 0.01), and were more likely to have a soft gland ( p < 0.01). PJ anastomosis type was not associated with morbidity but was associated with mortality (duct-to-mucosa vs. invagination, odds ratio = 0.22, p < 0.01). Among patients who developed a clinically relevant pancreatic fistula, none of the 119 duct-to-mucosa, compared with 5 of 21 invagination, patients died ( p < 0.01). Conclusion: Patients who undergo a PJ by duct-to-mucosa or invagination differ with respect to preoperative and intraoperative variables. When an invagination PJ leaks, there may be a greater influence on mortality than when a duct-to-mucosa PJ leaks.

Comparative study between invagination and duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy

“…In our work nonsignificant change regarding POPF in the study groups in contrast to Lavu et al, (14) study who presented those cases underwent a PJ by duct-to-mucosa or invaginations vary regarding pre-operative and intra-operative parameters. The POPF severity was noted higher in duct to mucosa PJ with nonsignificant changes.…”

A propensity score analysis of over 12,000 pancreaticojejunal anastomoses after pancreaticoduodenectomy: does technique impact the clinically relevant fistula rate?

“…Rivas et al 22 (N = 975, NSQIP 2014-2015) reported a significant increase in fistula rates after IG in patients with a soft pancreas. Lavu et al 23 (N = 890, 2011-2012) reported a significant increase in mortality with IG compared to DTM (OR = 1.8, p = 0.01), but no significant difference in POPF. The current study provides a new perspective for numerous reasons.…”

“…First, data was compiled over a longer and more recent time period with an N = 12,361, making this analysis the largest study on this topic to the authors' knowledge. 23 From this larger number of patients and the addition of many recently abstracted variables, IG was compared to DTM across 30 variables, enabling the statistical power to perform a propensity score analysis and to stratify the analysis by duct size and gland texture, heretofore not reported and intended to decrease bias between the groups. In an attempt to further decrease bias, we included a modified Fistula Risk Score (FRS) in the analysis to improve rigor and reproducibility.…”