Journal Article

Safety and efficacy of pancreaticogastrostomy for hepatopancreatoduodenectomy compared to pancreaticojejunostomy for perihilar cholangiocarcinoma

Kitagawa, Yuko, Nakano, Yutaka, Uemura, Sho, Nishiyama, Ryo, Abe, Yuta, Hasegawa, Yasushi, Hayatsu, Shigeo, Tanaka, Masayuki, Chiba, Naokazu, Udagawa, Daisuke, Kitago, Minoru, Odaira, Masanori, Hori, Shutaro, Kawachi, Shigeyuki, Mihara, Kisyo

2025

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adult / Aged / Ascites / Bile Duct Neoplasms - pathology / Bile Duct Neoplasms - surgery / Bile ducts / Cholangiocarcinoma / Comparative analysis / Effectiveness / Female / Follow-Up Studies / Gastrostomy / Gastrostomy - adverse effects / Gastrostomy - methods / Hepatectomy / Hepatectomy - adverse effects / Hepatectomy - methods / Hepatopancreatoduodenectomy / Hospitals / Humans / Jejunostomy / Klatskin Tumor - pathology / Klatskin Tumor - surgery / Liver / Liver diseases / Male / Medical colleges / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Methods / Middle Aged / Mortality / Operative Time / Pancreas / Pancreatic Fistula - epidemiology / Pancreatic Fistula - etiology / Pancreaticoduodenectomy / Pancreaticoduodenectomy - adverse effects / Pancreaticoduodenectomy - methods / Pancreaticogastrostomy / Pancreaticojejunostomy - adverse effects / Pancreaticojejunostomy - methods / Patient outcomes / Perihilar cholangiocarcinoma / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Postoperative pancreatic fistula / Prognosis / Retrospective Studies / Small intestine / Stomach / Surgery / Surgical Oncology / Sutures / Treatment Outcome / Veins & arteries