Comparison of reconstruction techniques after pancreatoduodenectomy: A single-center retrospective cohort study.

IF 2.5 3区医学 Q1 SURGERY Scandinavian Journal of Surgery Pub Date : 2025-01-10 DOI:10.1177/14574969241312287

Iago Justo Alonso, Paola Peralta Fernández-Revuelta, Alberto Marcacuzco Quinto, Oscar Caso Maestro, Laura Alonso Murillo, Carlos Jiménez-Romero

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Abstract

Background: There is controversy regarding which is the best reconstruction technique after the pancreatoduodenectomy. Currently, there are no studies comparing the three most frequent reconstruction techniques: Whipple + Roux-en-Y gastrojejunostomy (WRYGJ), pyloric-preserving + Billroth II (PPBII), and Whipple + BII (WBII).

Methods: Between 2012 and March 2023, 246 patients underwent pancreaticoduodenectomy with the following type of reconstruction techniques: (1) WRYGJ: 40 patients; (2) PPBII: 118 patients; and (3) WBII: 88 patients. A retrospective comparative study among these groups was performed.

Results: No significant differences were found among the groups regarding duration of the surgery, the blood volume transfused, or caliber of the Wirsung duct. The size and types of tumors, the degree of differentiation and tumor invasion of the peripancreatic tissue, vascular and neural structures, and lymph nodes were similar among the groups. The rate of R0 resection was lower in WBII (62.5% [55/88]) than in WRYGJ (75% [30/40]) and PPBII (72% [85/118]), but statistically insignificant among the groups (p = 0.232). The incidences of relevant B/C postoperative pancreatic fistula (POPF) were similar among the groups: 7.5% (7/40) in WRYGJ, 17% (20/118) in PPBI, and 26.2% (23/88) in WBII (p = 0.292). In addition, the incidence of B/C delayed gastric emptying (DGE) was higher in WBII (27.3% [24/88]) than in WRYGJ (20% [8/40]) and PPBII (19.5% [23/118]) but statistically insignificance among the groups (p = 0.381). The incidence of medical and surgical complications, intensive care unit and hospital stays, morbimortality at 90 days, and 5-year survival were similar among the groups. Multivariate analysis revealed that POPF grade B/C was a risk factor for DGE grade B/C (odds ratio (OR) = 9.903, 95% confidence interval (CI) = 4.829-20.310; p < 0.001), and a <3-mm Wirsung duct was a risk factor for POPF (OR = 3.604, 95% CI = 1.791-7.254; p < 0.001).

Conclusion: No technique was superior to the others. Only relevant POPF B/C was a risk factor for DGE B/C, and <3 mm Wirsung for a POPF.

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胰十二指肠切除术后重建技术的比较：单中心回顾性队列研究。

背景：关于胰十二指肠切除术后最佳的重建技术是有争议的。目前，没有研究比较三种最常见的重建技术：Whipple + Roux-en-Y胃空肠吻合术（WRYGJ）、幽门保留+ Billroth II （PPBII）和Whipple + BII （WBII）。方法：2012年至2023年3月，246例患者行胰十二指肠切除术，采用以下几种重建技术：(1)WRYGJ: 40例；(2) PPBII: 118例；WBII: 88例。对这些组进行回顾性比较研究。结果：两组在手术时间、输血量、Wirsung管口径等方面无显著差异。两组间肿瘤的大小、类型、分化程度、肿瘤对胰周组织、血管、神经结构及淋巴结的侵袭程度相似。WBII组R0切除率（62.5%[55/88]）低于WRYGJ组（75%[30/40]）和PPBII组（72%[85/118]），但组间差异无统计学意义（p = 0.232）。两组间相关B/C术后胰瘘（POPF）发生率相似：WRYGJ组为7.5% (7/40)，PPBI组为17% (20/118)，WBII组为26.2% (23/88)（p = 0.292）。此外，WBII组B/C胃排空延迟发生率（27.3%[24/88]）高于WRYGJ组（20%[8/40]）和PPBII组（19.5%[23/118]），但组间差异无统计学意义（p = 0.381）。两组患者的内科和外科并发症发生率、重症监护病房和住院时间、90天死亡率和5年生存率相似。多因素分析显示，POPF B/C级是DGE B/C级的危险因素(优势比(OR) = 9.903, 95%可信区间(CI) = 4.829-20.310；结论：没有一种方法优于其他方法。只有相关的POPF B/C是DGE B/C的危险因素

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来源期刊

Scandinavian Journal of Surgery 医学-外科

CiteScore

5.50

自引率

4.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The Scandinavian Journal of Surgery (SJS) is the official peer reviewed journal of the Finnish Surgical Society and the Scandinavian Surgical Society. It publishes original and review articles from all surgical fields and specialties to reflect the interests of our diverse and international readership that consists of surgeons from all specialties and continents.