Outcomes comparison of Pancreato-Gastrostomy and Isolated Jejunal Loop Pancreato-Jejunostomy following Pancreato-Duodenectomy in patients with soft pancreas and at moderate-high risk for POPF: a retrospective multicenter experience-based analysis

Abstract

Following pancreatoduodenectomy (PD), the modality of pancreato-enteric continuity restoration may impact on postoperative pancreatic fistula (POPF) risk. The aim of this study is to compare, among patients with soft pancreas and at moderate/high risk for POPF, the outcomes of PD with Pancreato-Gastrostomy (PG), versus Isolated Jejunal Loop Pancreato-Jejunostomy (IJL-PJ). 193 patients with a Callery Fistula Risk Score (C-FRS) ≥ 3 operated at 3 HPB Units, two performing PG and one IJL-PJ as their preferred anastomotic technique following PD (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) were included in this study (PG = 123, IJL-PJ = 70). Primary outcomes were POPF, clinically relevant (cr-)postoperative pancreatic hemorrhage (cr-PPH), delayed gastric emptying (cr-DGE), and postoperative major complications and mortality. POPF, cr-PPH, and cr-DGE occurred in 21.8%, 17.6%, and 11.4% of patients, and did not differ significantly between PG (26%, 19.5%, and 10.6%, respectively) and IJL-PJ (17.1%, 14.3%, and 12.9%, respectively; all p > 0.05) patients. Major (Dindo ≥ 3) complication and mortality rates were 26.4% and 3.3%, respectively, and did not differ significantly between PG (29.3% and 3.8%) and IJL-PJ (21.4% and 2.9) patients (p > 0.05). A faster surgical drain and nasogastric tube removal matched a significantly shorter hospitalization among IJL-PJ patients (median LOS: 18 days versus 25 days among PG patients, p < 0.001). In conclusion, IJL-PJ and PG, when performed by surgeons specialized with the concerned anastomotic technique in patients with soft pancreas and moderate/high risk for POPF, have similar results in terms of perioperative mortality and postoperative complications both overall and specific for PD.

Postoperative pancreatic fistula after pancreaticogastrostomy versus pancreatojejunostomy after pancreatic resection, a comparative systematic review and meta‐analysis

“…Most of the studies were conducted in Germany. [25][26][27][28]32,36,[46][47][48] The other studies were conducted in the USA, 17,20 France, 18,22,49 Italy, 21,43,45,51 Spain, 23,30 Brazil, 24 Belgium, 29,35 Egypt, 31,33 Canada, 34 Bulgaria, 37 China, 39,41 Sweden, 40 Japan, 19,42 India, 44 and Poland. 50 One study was multinational and was conducted at 17 international institutions in Canada, Italy, the USA, and the UK.…”

“…38 Out of the included studies, 13 were randomized controlled trials (RCTs), 17,19,[21][22][23][28][29][30]33,34,36,43,47 one was a case-control study, two were prospective nonrandomized trials, 18,44 two were observational studies, 26,50 and 17 were retrospective analyses of prospectively collected data. 20,24,25,27,31,32,35,[37][38][39][40][41][42]45,48,51 The included studies were published between 1995 and 2022 and presented data on 14,666 patients; 4547 underwent PG and 10,119 underwent PJ. The patients' mean or median age ranged from 53.3 to 68.1, and the male contribution ranged from 39.4% to 72.2%.…”

“…A comparison of the overall rate of POPF in the PG and PJ groups was mentioned in 24 studies. [17][18][19][20][22][23][24][25][26][27][29][30][31][32][33][34]37,39,41,43,46,[49][50][51] Their pooled analysis revealed a statistically significant lower POPF rate in the PG group (p = 0.044, OR = 0.78, and 95% CI: 0.612-0.994) (Figure 2).…”

“…The length of hospital stay (LOS) was described in 16 studies 17,21,23,27,34,36,37,39,[41][42][43][44][45][49][50][51] with no statistically significant difference between both groups (MD = 0.955 days and p = 0.228) (Figure 8).…”

“…The amount of intraoperative blood loss did not significantly differ between the two groups (MD = 8.88 cc and p = 0.753). This was extracted from 18 studies [17][18][19][20]23,28,29,33,34,36,39,[41][42][43][44][45]50,51 (Figure 7).…”