Pancreatico‐jejunostomy decreases post‐operative pancreatic fistula incidence and severity after central pancreatectomy

Abstract

Backgrounds: Central pancreatectomy (CP) is an alternative to pancreaticoduodenectomy and distal pancreatectomy in benign tumours of pancreatic isthmus management. It is known for a high post-operative pancreatic fistula (POPF) rate. The purpose of this study was to compare POPF incidence between pancreatico-jejunostomy (PJ) and pancreaticogastrostomy (PG). Methods: Fifty-eight patients (mean age 53.9 AE 1.9 years) who underwent a CP in four French University Hospitals from 1988 to 2011 were analysed. The distal pancreatic remnant was either anastomosed to the stomach (44.8%, n = 25) or to a Roux-en-Y jejunal loop (55.2%, n = 35) with routine external drainage allowing a systematic search for POPF. POPF severity was classified according to the International Study Group on Pancreatic Fistula (ISGPF) and Clavien-Dindo classifications. Results: The groups were similar on sex ratio, mean age, ASA score, pancreas texture, operative time and operative blood loss. Mean follow-up was 36.2 AE 3.9 months. POPF were significantly more frequent after PG (76.9 versus 37.5%, P = 0.003). PG was associated with significantly higher grade of POPF both when graded with ISGPF classification (P = 0.012) and Clavien-Dindo classification (P = 0.044). There was no significant difference in postoperative bleeding (0.918) and delayed gastric emptying (0.877) between the two groups. Hospital length of stay was increased after PG (23.6 AE 3.5 days versus 16.5 AE 1.9 days, P = 0.071). There was no significant difference in incidence of long-term exocrine (3.8 versus 19.2%, P = 0.134) and endocrine (7.7 versus 9.4%, P = 0.575) pancreatic insufficiencies. Conclusion: PG was associated with a significantly higher POPF incidence and severity in CP. We recommend performing PJ especially in older patients to improve CP outcomes.

Postoperative pancreatic fistula: a review of traditional and emerging concepts

“… 68 A meta-analysis of eight RCTs comparing 607 patients who underwent PG and 604 patients who underwent PJ revealed a significant reduction in POPF with the PG technique. 69 However, a recent retrospective cohort study of 58 patients undergoing CP has demonstrated a higher rate of POPF in patients receiving PG as opposed to PJ. 70 The authors hypothesize that this may be due to a greater amount of tension that exists in a PG anastomosis as opposed to PJ.…”

Laparoscopic spleen-preserving distal versus central pancreatectomy for tumors in the pancreatic neck and proximal body

“…Lv et al [27] reported that overall complications rate of traditional CP was higher as compared with outcomes following DP (68.7 vs 23%, P = .003). It was also indicated that the overall complications rate of LCP and LSPDP groups in this study was lower than traditional CP and DP reported in literature, [20,27,28] that might attribute to the fact that laparoscopic surgery was more accurate and with less tissue injured. [10] POPF is considered as most spiny and risky complication after pancreatectomy.…”

“…In conventional CP procedure, the distal pancreas stump is anastomosed to the jejunum with Roux-en-Y enteroenterostomy reconstruction. [20] Compared with LSPDP, the additional reconstruction of LCP is more inconformity with physiological structure of human. It was shown that the postoperative exhaust time in patients undergoing LCP was significantly longer than LSPDP (4.4 ± 1.6 vs 2.5 ± 0.9 days, P = .001).…”

“…The distal pancreas was anastomosed to the jejunum because of mucosa anastomosis with Roux-en-Y reconstruction. [20]…”

Hazards of predatory publication

“…In this issue of the journal, an article is accompanied by a Publisher's note to indicate that an earlier version of the paper was published elsewhere, reportedly without the author's consent and without the signature of a Copyright Agreement or License between the author and the Publisher. The matter was drawn to our attention by the authors and has been investigated by the Editorial Office.…”