Surgical Outcome of Pancreaticoduodenectomy in Patients with a History of Roux‐en‐Y Reconstruction after Tumor Removal

Abstract

Background The need for pancreaticoduodenectomy (PD) after Roux‐en‐Y (RY) reconstruction after tumor removal is expected to increase in future, but current studies on outcome are sparse. This surgery is challenging, due to intraabdominal adhesions and/or anatomical changes introduced by the previous abdominal surgery. Here, we investigated the surgical outcomes of PD after RY reconstruction following tumor removal. Methods We enrolled 283 patients that underwent PD. Surgical outcomes for PD were compared between patients with or without a history of RY reconstruction after tumor removal. Outcomes were also compared between two different surgical procedures for the post‐PD reconstruction. Results Among 283 patients, 11 had a history of RY reconstruction after tumor removal (3.9%). Among these, RY reconstructions had been performed where the small intestine was anastomosed to a remnant stomach after distal gastrectomy (n = 2), to remnant stomach after proximal gastrectomy (n = 1), to the esophagus after total gastrectomy (n = 6), or to the hepatic duct after extrahepatic bile duct resection (n = 2). Surgical outcomes were not significantly different between cases with and without RY reconstructions. We identified two different reconstruction procedures after removing the periampullary tumor during PD. The surgical outcomes were not significantly different between these two reconstruction groups. Conclusions The surgical outcome of PD was not significantly affected by a history of RY reconstruction. Similarly, the type of reconstruction performed during PD did not significantly affect the outcome. These results could be useful when planning PD in patients with a history of RY reconstruction after tumor removal.