Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 1901-1909
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1901
Safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy during pancreatoduodenectomy: A retrospective cohort study
Yi Sun, Xiao-Feng Yu, Han Yao, Shi Xu, Yu-Qiao Ma, Chen Chai
Yi Sun, Xiao-Feng Yu, Han Yao, Shi Xu, Yu-Qiao Ma, Chen Chai, Department of General Surgery, The People’s Hospital of Suzhou New District, Suzhou 215000, Jiangsu Province, China
Author contributions: Sun Y and Chai C contributed to conceptualization; Yao H and Yu XF contributed to investigation; Ma YQ and Xu S contributed to data curation; Sun Y contributed to writing – original draft preparation; Sun Y and Chai C contributed to writing – review & editing; All authors read and approved the final manuscript.
Supported by Clinical Medical Science and Technology Development Foundation of Jiangsu University, No. JLY2021118; Science and Technology Project of Suzhou City, No. SKJY2021039.
Institutional review board statement: This retrospective study conformed with the ethical guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of The People’s hospital of Suzhou New District.
Informed consent statement: Written informed consent was obtained from all the subjects involved in this study.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of the manuscript was prepared and revised according to the Statement- checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen Chai, MBBS, MD, Chief Doctor, Professor, Surgeon, Department of General Surgery, The People’s Hospital of Suzhou New District, No. 95 Huashan Road, High-tech Zone, Suzhou, Suzhou 215000, Jiangsu Province, China. chaich@lzu.edu.cn
Received: May 20, 2023
Peer-review started: May 20, 2023
First decision: July 8, 2023
Revised: July 20, 2023
Accepted: August 4, 2023
Article in press: August 4, 2023
Published online: September 27, 2023
Processing time: 125 Days and 1.3 Hours
Abstract
BACKGROUND

Pancreatoduodenectomy (PD) is the most effective surgical procedure to remove a pancreatic tumor, but the prevalent postoperative complications, including postoperative pancreatic fistula (POPF), can be life-threatening. Thus far, there is no consensus about the prevention of POPF.

AIM

To determine possible prognostic factors and investigate the clinical effects of modified duct-to-mucosa pancreaticojejunostomy (PJ) on POPF development.

METHODS

We retrospectively collected and analyzed the data of 215 patients who underwent PD between January 2017 and February 2022 in our surgery center. The risk factors for POPF were analyzed by univariate analysis and multivariate logistic regression analysis. Then, we stratified patients by anastomotic technique (end-to-side invagination PJ vs modified duct-to-mucosa PJ) to conduct a comparative study.

RESULTS

A total of 108 patients received traditional end-to-side invagination PJ, and 107 received modified duct-to-mucosa PJ. Overall, 58.6% of patients had various complications, and 0.9% of patients died after PD. Univariate and multivariate logistic regression analyses showed that anastomotic approaches, main pancreatic duct (MPD) diameter and pancreatic texture were significantly associated with the incidence of POPF. Additionally, the POPF incidence and operation time in patients receiving modified duct-to-mucosa PJ were 11.2% and 283.4 min, respectively, which were significantly lower than those in patients receiving traditional end-to-side invagination PJ (27.8% and 333.2 minutes).

CONCLUSION

Anastomotic approach, MPD diameter and pancreatic texture are major risk factors for POPF development. Compared with traditional end-to-side invagination PJ, modified duct-to-mucosa PJ is a simpler and more efficient technique that results in a lower incidence of POPF. Further studies are needed to validate our findings and explore the clinical applicability of our technique for laparoscopic and robotic PD.

Keywords: Pancreaticojejunostomy; Pancreatoduodenectomy; Suture technique; Pancreatic fistula

Core Tip: We evaluated the safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy (PJ) during pancreatoduodenectomy (PD) by analyzing the data of 215 patients who underwent PD in our surgery center. Compared with traditional end-to-side invagination PJ, modified duct-to-mucosa PJ was a simpler and more efficient technique that resulted in a lower incidence of postoperative pancreatic fistula (11.2%). Meanwhile, we found that anastomotic approach, main pancreatic duct diameter and pancreatic texture were major risk factors for postoperative pancreatic fistula development.