{"title":"Safety and efficacy of pancreaticogastrostomy for hepatopancreatoduodenectomy compared to pancreaticojejunostomy for perihilar cholangiocarcinoma.","authors":"Yutaka Nakano, Yuta Abe, Daisuke Udagawa, Minoru Kitago, Yasushi Hasegawa, Shutaro Hori, Masayuki Tanaka, Sho Uemura, Masanori Odaira, Kisyo Mihara, Ryo Nishiyama, Naokazu Chiba, Shigeo Hayatsu, Shigeyuki Kawachi, Yuko Kitagawa","doi":"10.1186/s12957-025-03737-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hepatopancreatoduodenectomy (HPD) is one of the most challenging surgeries for perihilar cholangiocarcinoma. Postoperative pancreatic fistula (POPF) is a critical and fatal complication. The safety and efficacy of pancreaticogastrostomy (PG) for HPD compared to pancreaticojejunostomy (PJ) remain unclear. In this study, we aimed to investigate and compare the short-term outcomes of PG and PJ for HPD in terms of the POPF rate.</p><p><strong>Methods: </strong>Two groups of patients (PG group vs. PJ group) were retrospectively compared between January 2013 and January 2024. The reconstruction method was changed from PJ to PG in March 2021.</p><p><strong>Results: </strong>A total of 50 patients were enrolled in this study. The PG and PJ groups comprised 15 (30.0%) and 35 (70.0%) patients, respectively. In the PJ group, three (8.6%) patients died after surgery because of clinically relevant POPF (CR-POPF), intraabdominal bleeding, and post-hepatectomy liver failure. The operative time was longer in the PG group (909 min vs. 706 min, P = 0.020); however, the CR-POPF rate was lower in the PG group than in the PJ group (0 [0%] vs. 19 [54.3%], P < 0.001). Moreover, the number of patients who developed massive postoperative ascites (≥ 1,500 mL/day) was lower in the PG group than in the PJ group (3 [20.0%] vs. 16 [45.7%] patients, P = 0.028).</p><p><strong>Conclusions: </strong>Changing the method of pancreatic reconstruction for HPD from PJ to PG improved the short-term outcomes of patients at our institution. PG reconstruction is safe and effective for HPD as it reduces the incidence of CR-POPF.</p>","PeriodicalId":23856,"journal":{"name":"World Journal of Surgical Oncology","volume":"23 1","pages":"97"},"PeriodicalIF":2.5000,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924735/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12957-025-03737-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hepatopancreatoduodenectomy (HPD) is one of the most challenging surgeries for perihilar cholangiocarcinoma. Postoperative pancreatic fistula (POPF) is a critical and fatal complication. The safety and efficacy of pancreaticogastrostomy (PG) for HPD compared to pancreaticojejunostomy (PJ) remain unclear. In this study, we aimed to investigate and compare the short-term outcomes of PG and PJ for HPD in terms of the POPF rate.
Methods: Two groups of patients (PG group vs. PJ group) were retrospectively compared between January 2013 and January 2024. The reconstruction method was changed from PJ to PG in March 2021.
Results: A total of 50 patients were enrolled in this study. The PG and PJ groups comprised 15 (30.0%) and 35 (70.0%) patients, respectively. In the PJ group, three (8.6%) patients died after surgery because of clinically relevant POPF (CR-POPF), intraabdominal bleeding, and post-hepatectomy liver failure. The operative time was longer in the PG group (909 min vs. 706 min, P = 0.020); however, the CR-POPF rate was lower in the PG group than in the PJ group (0 [0%] vs. 19 [54.3%], P < 0.001). Moreover, the number of patients who developed massive postoperative ascites (≥ 1,500 mL/day) was lower in the PG group than in the PJ group (3 [20.0%] vs. 16 [45.7%] patients, P = 0.028).
Conclusions: Changing the method of pancreatic reconstruction for HPD from PJ to PG improved the short-term outcomes of patients at our institution. PG reconstruction is safe and effective for HPD as it reduces the incidence of CR-POPF.
背景：肝胰十二指肠切除术（HPD）是肝门周围胆管癌最具挑战性的手术之一。术后胰瘘（POPF）是一种严重且致命的并发症。与胰空肠吻合术（PJ）相比，胰胃吻合术（PG）治疗HPD的安全性和有效性尚不清楚。在这项研究中，我们旨在调查和比较PG和PJ治疗HPD在POPF率方面的短期结果。方法：回顾性比较2013年1月至2024年1月两组患者（PG组与PJ组）。2021年3月，重建方法由PJ改为PG。结果：本研究共纳入50例患者。PG组15例（30.0%），PJ组35例（70.0%）。在PJ组中，3例（8.6%）患者因临床相关的POPF （CR-POPF）、腹内出血和肝切除术后肝功能衰竭而术后死亡。PG组手术时间更长（909 min vs 706 min, P = 0.020）；然而，PG组的CR-POPF率低于PJ组（0 [0%]vs. 19[54.3%]）。结论：将HPD的胰腺重建方法从PJ改为PG改善了我院患者的短期预后。PG重建对于HPD是安全有效的，因为它可以降低CR-POPF的发生率。
期刊介绍：
World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics.
Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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