Comparison of anastomotic patency and remnant pancreatic function between invagination and duct-to-mucosa pancreaticojejunostomy: A follow-up study of a randomized trial.
While invagination pancreaticojejunostomy may reduce the risk of postoperative pancreatic fistula after pancreatoduodenectomy, its long-term impact on anastomotic patency and remnant pancreatic function remains unclear.
To compare long-term anastomotic patency and remnant pancreatic function between duct-to-mucosa pancreaticojejunostomy and invagination pancreaticojejunostomy after pancreatoduodenectomy.
In this retrospective study, we reviewed data from 120 patients from a previous randomized trial comparing the incidence of pancreatic fistula between duct-to-mucosa pancreaticojejunostomy and invagination pancreaticojejunostomy (UMIN000005890; 2011-2015). Remnant pancreatic duct dilatation and anastomotic stricture were evaluated as surrogate markers for late-term anastomotic patency. Benign anastomotic stricture was defined as an endoscopically confirmed narrowing of the anastomosis. Remnant pancreatic volume, fatty liver disease, and new-onset or worsening type 2 diabetes mellitus were evaluated as markers of exocrine and endocrine function.
The frequency of benign remnant pancreatic duct dilatation was 18.6% in patients who underwent invagination pancreaticojejunostomy and 9.8% in those who underwent duct-to-mucosa pancreaticojejunostomy (P = .262). The 3- and 5-year cumulative incidences were 9.3% and 19.9%, respectively, for invagination pancreaticojejunostomy versus 9.5% and 13.4%, respectively, for duct-to-mucosa pancreaticojejunostomy (P = .356). Benign anastomotic stricture occurred in 9 patients (invagination pancreaticojejunostomy: n = 5; duct-to-mucosa pancreaticojejunostomy: n = 4), with no significant difference between groups. Among those with remnant pancreatic duct dilatation, some developed pancreatic pain or pancreatolithiasis, whereas no such symptoms were seen in patients without remnant pancreatic duct dilatation. Remnant pancreatic volume, fatty liver disease, and the incidence of type 2 diabetes mellitus were similar between groups.
Radiologic suspicion of impaired patency and pancreatic functions was comparable between invagination pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy. Although remnant pancreatic duct dilatation occurred occasionally, its clinical impact is likely to be relatively minimal.
To compare long-term anastomotic patency and remnant pancreatic function between duct-to-mucosa pancreaticojejunostomy and invagination pancreaticojejunostomy after pancreatoduodenectomy.
In this retrospective study, we reviewed data from 120 patients from a previous randomized trial comparing the incidence of pancreatic fistula between duct-to-mucosa pancreaticojejunostomy and invagination pancreaticojejunostomy (UMIN000005890; 2011-2015). Remnant pancreatic duct dilatation and anastomotic stricture were evaluated as surrogate markers for late-term anastomotic patency. Benign anastomotic stricture was defined as an endoscopically confirmed narrowing of the anastomosis. Remnant pancreatic volume, fatty liver disease, and new-onset or worsening type 2 diabetes mellitus were evaluated as markers of exocrine and endocrine function.
The frequency of benign remnant pancreatic duct dilatation was 18.6% in patients who underwent invagination pancreaticojejunostomy and 9.8% in those who underwent duct-to-mucosa pancreaticojejunostomy (P = .262). The 3- and 5-year cumulative incidences were 9.3% and 19.9%, respectively, for invagination pancreaticojejunostomy versus 9.5% and 13.4%, respectively, for duct-to-mucosa pancreaticojejunostomy (P = .356). Benign anastomotic stricture occurred in 9 patients (invagination pancreaticojejunostomy: n = 5; duct-to-mucosa pancreaticojejunostomy: n = 4), with no significant difference between groups. Among those with remnant pancreatic duct dilatation, some developed pancreatic pain or pancreatolithiasis, whereas no such symptoms were seen in patients without remnant pancreatic duct dilatation. Remnant pancreatic volume, fatty liver disease, and the incidence of type 2 diabetes mellitus were similar between groups.
Radiologic suspicion of impaired patency and pancreatic functions was comparable between invagination pancreaticojejunostomy and duct-to-mucosa pancreaticojejunostomy. Although remnant pancreatic duct dilatation occurred occasionally, its clinical impact is likely to be relatively minimal.
Authors
Ojio Ojio, Natsume Natsume, Shimizu Shimizu, Asano Asano, Okuno Okuno, Hara Hara, Okuno Okuno, Matsuo Matsuo, Komori Komori, Abe Abe
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