Impact of Reconstruction Methods on Outcome of Pancreatoduodenectomy in Pancreatic Cancer Patients

Abstract

Local recurrence is one of the most frequent forms of pancreatic cancer recurrence, although local recurrence is rare for other periampullary cancers. Because the type of recurrence and outcome differ depending on the type of cancer, these factors should be considered when the type of reconstruction is chosen. Fifty-four pancreatoduodenectomies were performed in patients with ductal adenocarcinoma of the pancreas from 1994 to 2001. Billroth I reconstruction was performed in 27 consecutive patients before 1999, and thereafter Billroth II reconstruction was performed in another consecutive 27 patients. Postoperative nasogastric intubation and the duration before oral ingestion were longer for Billroth I patients than Billroth II patients. Seven complications occurred in Billroth I patients, whereas there were two complications in Billroth II patients. Disease-free survival and overall survival were not different between the two groups; however, bypass operations were required in nine patients of the Billroth I group and in one patient of the Billroth II group. Percutaneous transhepatic cholangio-drainage (PTCD) procedures were required in six patients of the Billroth I goup and in two patients of the Billroth II group. The Billroth II reconstruction may have some advantages over the Billroth I reconstruction in terms of postoperative oral ingestion and avoiding bypass surgery and PTCD at the time of recurrence.

A Modified Technique of End‐to‐End Pancreaticojejunostomy With Transpancreatic Interlocking Mattress Sutures

“…By now, PD has become the standard and the only curative treatment available for periampullary malignant tumors. Despite the advances in surgical techniques and in the pre‐ and postoperative care available in specialized centers over the last two decades, PD is still associated with a 40% morbidity rate 1, 2, 19, 20. The major surgical complications are POPF, hemorrhage, abscess, and DGE.…”

Invaginated Pancreaticojejunostomy via the Space Behind the Root of Superior Mesenteric Vessels

“…Although there are many different anastomotic methods [5, 6], none of them could eliminate the occurrence of PF. A report by the Massachusetts General Hospital demonstrated an incidence of 9.6% of PF in 733 patients underwent PD in the recent 10 years [7]. …”

The Best Choice to Achieve Zero Complications after Pancreatoduodenectomy

“…Furthermore, in consideration of early postoperative complications, more frequent anastomotic failure of the pancreatojejunostomy using the Billroth I method has been reported than with other procedures [9]. Although the cause of this failure remains unclear, the angularity of the jejunal loop might be related to these problems [10] and, as described previously, we suspect the mixture of bile and pancreatic juice-induced enzyme activation to be associated with damage to the tissue [11]. Delayed gastric emptying (DGE), which is critical for the determination of nutritional status, has also been a concern following Billroth I reconstruction.…”