Wrapping double-mattress anastomosis for pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy can significantly reduce postoperative pancreatic fistula rate compared with conventional pancreaticojejunostomy in open surgery: An analysis of a propensity score-matched sample. (September 2021)

• Record Type: Journal Article
• Authors: Kiguchi, Gozo; Sugioka, Atsushi; Uchida, Yuichiro; Yoshikawa, Junichi; Nakauchi, Masaya; Kojima, Masayuki; Tanahashi, Yoshinao; Takahara, Takeshi; Yasuda, Akira; Suda, Koichi; Kato, Yutaro; Uyama, Ichiro
• Is Part Of: Surgical oncology. Volume 38(2021)
• Publication Date: 2021-09
• Subjects: Pancreaticoduodenectomy -- Pancreaticojejunostomy -- Pancreatic fistula; ASA American Society of Anesthesiologists -- BMI body mass index -- C-MIPD conventional-minimally invasive pancreaticoduodenectomy -- CT computed tomography -- d standardized mean differences -- ISGPS International Study Group on Pancreatic Surgery -- LPD laparoscopic pancreaticoduodenectomy -- L/S ratio liver‐to‐spleen attenuation ratio -- MIPD minimally invasive pancreaticoduodenectomy -- NAFLD nonalcoholic fatty liver disease -- OPD open pancreaticoduodenectomy -- PD pancreaticoduodenectomy -- PJ pancreaticojejunostomy -- POPF postoperative pancreatic fistula -- PSM propensity score matching -- ROC receiver operating characteristic -- RPD robotic pancreaticoduodenectomy; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2021.101577
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is technically demanding because of pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) is the most serious complication of MIPD and open pancreaticoduodenectomy (OPD). Contrary to expectations, conventional PJ in MIPD did not improve POPF rate and length of hospital stay. High POPF rates are attributed to technical issues encountered during MIPD, which include motion restriction and insufficient water tightness. Therefore, we developed wrapping double-mattress anastomosis, the Kiguchi method, which is a novel PJ technique that can improve MIPD. Herein, we describe the Kiguchi method for PJ in MIPD and compare the outcomes between this technique and conventional PJ in OPD. Methods: The current retrospective study included 83 patients in whom the complete obstruction of the main pancreatic duct by pancreatic tumors was absent on preoperative imaging. This research was performed from September 2016 to August 2020 at Fujita Health University Hospital. All patients were evaluated as having a soft pancreatic texture, which is the most important factor associated with POPF development. Briefly, 50 patients underwent OPD with conventional PJ (OPD group). Meanwhile, 33 patients, including 15 and 18 who had LPD and RPD, respectively, underwent MIPD using the Kiguchi method (MIPD group). After a 1:1 propensity score matching, 30 patients in the OPD group were matched to 30 patients in the MIPD group. Results: The patients' preoperative data did not differ. The grade B/C POPF rate was significantly lower in the MIPD group than in the OPD group (6.7% vs 40.0%, p = 0.002). The MIPD group had a significantly shorter median length of hospital stay than the OPD group (24 vs 30 days, p = 0.004). Conclusion: The novel Kiguchi method in MIPD significantly reduced the POPF rate in patients without complete obstruction of the main pancreatic duct. Highlights: A novel Wrapping double-mattress anastomosis (Kiguchi method) for pancreaticojejunostomy (PJ) was developed. In MIPD group, PJ using the Kiguchi method was performed in minimally invasive surgery. In OPD group, conventional PJ was performed in open surgery. POPF rates were compared between MIPD and OPD groups using a propensity score-matched analysis. After matching, Kiguchi method in MIPD was found to significantly reduce POPF rate.