Which pancreaticoduodenectomy dunking conduit is optimal for very small pancreatic ducts?

Patricia C. Conroy; Alexa Glencer; Sarah Mohamedaly; Lucia Calthorpe; Joseph Lin; Fernanda Romero-Hernandez; Kenzo Hirose; Eric Nakakura; Carlos Corvera; Kimberly S. Kirkwood; Ajay V. Maker; Adnan Alseidi; Mohamed A. Adam

Clinical Surgical Oncology (Jun 2023)

Which pancreaticoduodenectomy dunking conduit is optimal for very small pancreatic ducts?

Patricia C. Conroy,
Alexa Glencer,
Sarah Mohamedaly,
Lucia Calthorpe,
Joseph Lin,
Fernanda Romero-Hernandez,
Kenzo Hirose,
Eric Nakakura,
Carlos Corvera,
Kimberly S. Kirkwood,
Ajay V. Maker,
Adnan Alseidi,
Mohamed A. Adam

Affiliations

Patricia C. Conroy: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Alexa Glencer: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Sarah Mohamedaly: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Lucia Calthorpe: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Joseph Lin: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Fernanda Romero-Hernandez: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Kenzo Hirose: Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Eric Nakakura: Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Carlos Corvera: Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Kimberly S. Kirkwood: Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Ajay V. Maker: Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Adnan Alseidi: Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA
Mohamed A. Adam: Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA; Corresponding author. Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, Room S-321, San Francisco, CA, 94143, USA.

Journal volume & issue: Vol. 2, no. 2
p. 100014

Abstract

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Background: Pancreaticoduodenectomy data regarding the optimal technique for reconstruction of small pancreatic ducts, where duct-to-mucosa is technically difficult, are lacking. We sought to retrospectively evaluate outcomes of dunking pancreaticojejunostomy (DPJ) compared to dunking pancreaticogastrostomy (DPG) after pancreaticoduodenectomy. Methods: Using NSQIP-targeted pancreatectomy data (2014–2019), we retrospectively identified patients undergoing elective pancreaticoduodenectomy with small pancreatic ducts (<3 mm) who underwent DPJ or DPG. Outcomes between patients undergoing DPJ versus DPG were compared using multivariable regression. Results: Among 780 patients, 79.8% underwent DPJ and 20.1% DPG. Patient comorbidities were similar. More patients who underwent DPG were Black, underwent vascular reconstruction (29.0% v. 10.5%; p < 0.001), and had shorter operative time (324 v. 377 min; p < 0.001). After adjustment, DPJ reconstruction was associated with higher likelihood of clinically-relevant postoperative pancreatic fistula (CR-POPF) (OR 2.1; p = 0.024), deep abscess (OR 1.9; p = 0.041), and postoperative percutaneous drainage (OR 2.2; p = 0.027). There was no difference in delayed gastric emptying, postoperative sepsis, transfusions, reoperation, length of stay, or 30-day readmission. Conclusion: Among patients with small pancreatic ducts where a dunking pancreaticoenteric anastomosis is performed, DPG was associated with decreased CR-POPF incidence compared to DPJ. Future clinical trials are needed to confirm the generalizability of this result across centers with varying DPG expertise.

Published in Clinical Surgical Oncology

ISSN: 2773-160X (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.sciencedirect.com/journal/clinical-surgical-oncology

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