Annals of gastroenterological surgery · 2024
Low incidence of pancreatic fistula and well-preserved endocrine function with non-reconstructed small remnant pancreas after pancreaticoduodenectomy.
СтатьяНазвание и аннотация: Перевод в очереди
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Miyashita Mamiko, Yoshioka Ryuji, Fukumura Yuki, Takamatsu Manabu, Oba Atsushi, Ono Yoshihiro, Inoue Yosuke, Mise Yoshihiro, Takahashi Yu, Saiura Akio
Аннотация
AIM: Pancreatic reconstruction after pancreaticoduodenectomy (PD) that leaves a small remnant pancreas is often difficult. Pancreatic fistula is a major complication after PD, and fistulas are rare in patients with hard pancreas. However, the clinical impact of non-reconstructed small remnant after PD with hard pancreas is unknown.
METHODS: We included all patients who underwent PD for pancreatic tumor without pancreatic reconstruction in two institutions supervised by one surgeon between January 2004 and March 2021. Their short- or long-term outcome after surgery was retrospectively analyzed.
RESULTS: PD was performed in 774 patients, of whom 16 patients were without reconstruction (2.1%) with negative margins at the pancreatic stump. Pancreatic transection was performed above or to the left of the superior mesenteric artery, with a median remnant pancreas length of 3.7 cm (range, 1.3-10.0). A major complication (≥ Clavien-Dindo Grade IIIa) occurred in one patient (6%). Fistula of grade B occurred in one patient (6%). After a median follow-up of 44 months (95%CI, 10.6-77.3), insulin administration was unnecessary in 11 patients.
CONCLUSION: The preservation of a small pancreatic remnant without reconstruction after PD can be performed safely and may enable the keeping of pancreatic endocrine function for some selected patients with hard pancreas.
METHODS: We included all patients who underwent PD for pancreatic tumor without pancreatic reconstruction in two institutions supervised by one surgeon between January 2004 and March 2021. Their short- or long-term outcome after surgery was retrospectively analyzed.
RESULTS: PD was performed in 774 patients, of whom 16 patients were without reconstruction (2.1%) with negative margins at the pancreatic stump. Pancreatic transection was performed above or to the left of the superior mesenteric artery, with a median remnant pancreas length of 3.7 cm (range, 1.3-10.0). A major complication (≥ Clavien-Dindo Grade IIIa) occurred in one patient (6%). Fistula of grade B occurred in one patient (6%). After a median follow-up of 44 months (95%CI, 10.6-77.3), insulin administration was unnecessary in 11 patients.
CONCLUSION: The preservation of a small pancreatic remnant without reconstruction after PD can be performed safely and may enable the keeping of pancreatic endocrine function for some selected patients with hard pancreas.