What is the pancreatic duct size limit for a safe duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy? A retrospective study

Kit-Fai Lee; Kandy Kam Cheung Wong; Eugene Yee Juen Lo; Janet Wui Cheung Kung; Hon-Ting Lok; Charing Ching Ning Chong; John Wong; Paul Bo San Lai; Kelvin Kwok Chai Ng

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저자정보: Kit-Fai Lee (The Chinese University of Hong Kong) Kandy Kam Cheung Wong (The Chinese University of Hong Kong) Eugene Yee Juen Lo (The Chinese University of Hong Kong) Janet Wui Cheung Kung (The Chinese University of Hong Kong) Hon-Ting Lok (The Chinese University of Hong Kong) Charing Ching Ning Chong (The Chinese University of Hong Kong) John Wong (The Chinese University of Hong Kong) Paul Bo San Lai (The Chinese University of Hong Kong) Kelvin Kwok Chai Ng (The Chinese University of Hong Kong)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제26권 제1호

발행연도: 2022.2

수록면: 84 - 90 (7page)

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Backgrounds/Aims: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a dreadful complication. Duct-to-mucosa pancreaticojejunostomy (DTMPJ) is a commonly performed anastomosis after PD. This study aims to evaluate whether there is a size limit of pancreatic duct below which POPF rate increases significantly after DTMPJ.
Methods: A retrospective study was performed from a database with prospectively collected data on consecutive patients undergoing DTMPJ.
Results: Between the years 2003 and 2019, a total of 288 patients with DTMPJ were recruited. POPF occurred in 56.3% of the patients, of which 43.8% were biochemical leak, 8.7% were grade B, and 1.4% were grade C. Overall operative morbidity was 51.4%, of which 19.1% were major complications. Five patients (1.7%) died within 90 days of operation. Patients with grade B/C POPF had significantly soft pancreas (p < 0.001), smaller duct size (p = 0.031), and a diagnosis of carcinoma of the pancreas (p = 0.027). When a clinically significant POPF rate was analysed based on the pancreatic duct diameter, pancreatic duct size ≤ 1 mm had the highest POPF rate (35.7%). There was a significant difference in POPF rate between adjacent ductal diameter ≤ 1 mm and > 1 mm to 2 mm (35.7% vs 13.3%; p = 0.040). Multivariable analysis showed that for the soft pancreas, pancreatic duct diameter ≤ 1 mm was the only significant predictive factor for POPF (p = 0.027).
Conclusions: DTMPJ can be safely performed for pancreatic duct > 1 mm without significantly increased POPF risk.

#Pancreaticoduodenectomy #Pancreaticojejunostomy #Pancreatic fistula

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