Residual pancreatic function after pancreaticoduodenectomy is better preserved with pancreaticojejunostomy than pancreaticogastrostomy: A long-term analysis |
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| Affiliation: | 1. Gastroenterology B, Department of Medicine, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy;2. General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy;3. Radiology, Department of Diagnosis and of Pathology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy;1. Department of Medicine, Yale University, New Haven, CT, USA;2. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA;3. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA;4. Department of Medicine, Saint Louis University, St. Louis, MO, USA;5. Digestive Health Specialists, Tupelo, MS, USA;6. Department of Medicine, University of Michigan, Ann Arbor, MI, USA;7. Department of Medicine, Brigham and Women''s Hospital, Boston, MA, USA;8. Department of Medicine, Ohio State University, Columbus, OH, USA;9. Department of Medicine, Medical University of South Carolina, Charleston, SC, USA;10. Department of Medicine, University of Florida, Gainesville, FL, USA;11. Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA;12. Gastro Health and Miami Cancer Institute, Miami, FL, USA;13. Associates LLC, Aurora Health Care, St. Luke''s Medical Center, Milwaukee, WI, USA;14. Department of Medicine, Mayo Clinic, Jacksonville, FL, USA;15. Palmetto Health, Columbia, SC, USA;p. Richmond Gastroenterology Associates, St. Mary''s Hospital, Richmond, VA, USA;q. Department of Medicine, Indiana University, Indianapolis, IN, USA;r. Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA;s. Department of Cell Biology & Physiology, University of Pittsburgh, Pittsburgh, PA, USA;t. Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA;u. Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA;1. Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan;2. Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan;3. Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan;4. Ishikawacho Medical Clinic, Yokohama, Kanagawa, Japan;5. Yokosuka Mutual Aid Hospital, Yokosuka, Kanagawa, Japan;6. J-Oil Mills, Inc., Yokohama, Kanagawa, Japan;7. Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan;1. Department of Physics, University of Salerno, Salerno, Italy;2. Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy;3. Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy;4. Diagnostica Cavallo, Centro Ricerca Albo Laboratori MIUR DM 593/2000, Salerno, Italy;5. Mega Ellas, Consorzio Cooperative MMG, Salerno, Italy;6. ISC-CNR, Istituto Sistemi Complessi del CNR, Rome, Italy |
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| Abstract: | ![]()
BackgroundPancreatico-enteric anastomosis after pancreaticoduodenectomy can be performed using either a pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG). Differences in surgical outcomes are still a matter of debate, and less is known about long-term functional outcomes.MethodsTwelve years after the conclusion of a comparative study evaluating the surgical outcomes of PJ and PG (Bassi et al., Ann Surg 2005), available patients underwent morphological and functional pancreatic assessment: pancreatic volume and duct diameter measured by MRI, impaired secretion after secretin, fecal fat, fecal elastase-1 (FE-1), serum vitamin D and endocrine function. Quality of life and symptom scores were evaluated with the EORTC QLQ-C30 questionnaire.ResultsOnly 34 patients were available for assessment. No differences were found in terms of BMI variation, endocrine function, quality of life or symptoms. Exocrine function was more severely impaired after PG than after PJ (fecal fats 26.6 ± 4.1 vs 18.2 ± 3.6 g/day; FE-1 121.4 ± 6.7 vs 170.2 ± 25.5 μg/g, vitamin D 18.1 ± 1.8 vs. 23.2 ± 3.1 ng/mL). MRI assessment identified a lower pancreatic volume (26 ± 3.1 vs. 36 ± 4.1 cm3) and a more dilated pancreatic duct (4.6 ± 0.92 vs. 2.4 ± 0.18 mm) in patients with PG compared to those with PJ.ConclusionCompared to PJ, PG is associated with a more severely impaired exocrine function long-term, but they result similar endocrine function and quality of life. In patients with a long life expectancy, this should be taken into account. |
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| Keywords: | Pancreaticoduodenectomy Pancreaticojejunostomy Pancreaticogastrostomy Diabetes Exocrine insufficiency |
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