Pancreatojejunostomy: Standing on the Shoulders of Giants. A Single Centre Retrospective Analysis

Overview

Journal Updates Surg

Specialty General Surgery

Date 2023 Sep 7

PMID 37679576

Authors

Michele Mazzola

Alessandro Giani

Pietro Calcagno

Antonio Benedetti

Andrea Zironda

Monica Gualtierotti

Paolo De Martini

Giovanni Ferrari

Affiliations

Soon will be listed here.

Abstract

Gaining experience in pancreatic surgery could be demanding especially when minimally invasive approach is used. Pancreatojejunostomy (PJ) is one of the most critical steps during pancreatoduodenectomy (PD). Our aim was to investigate the impact of a surgeon's experience in performing PJ, especially in a subgroup of patients undergoing laparoscopic PD (LPD). Data of consecutive patients undergoing PD from 2017 to 2022 were prospectively collected and retrospectively analyzed. Patients were divided into two groups: M group included patients in which PJ was performed by an experienced surgeon, D group included those receiving PJ by a less experienced one. The groups were compared in terms of postoperative outcomes. 187 patients were selected (157 in group M and 30 in group D). The cohorts differed in terms of median age (68 vs 74 years, p = 0.016), and previous abdominal surgery (41.4% vs 66.7%, p = 0.011), while no difference was found regarding risk of postoperative pancreatic fistula (POPF). The groups did not differ in terms of surgical outcomes. POPF rate was 15.9% and 10% in the M and D group (p = 0.578), respectively. Among patients undergoing laparoscopic PJ POPF rate was 16.0% and 17.7% in the M and D group (p = 0.867), respectively, without difference. No difference was found in terms of POPF in patients undergoing PD independently from the surgeon who performed the PJ, even during LPD. Moderate/high FRS, BMI > 30 kg/m and male sex, but not the surgeon who performed the PJ anastomosis, were independent predictors of POPF.

References

Kang J, Sohn H, Choi Y, Byun Y, Lee J, Lee M . The development and clinical efficacy of simulation training of open duct-to-mucosa pancreaticojejunostomy using pancreas and intestine silicone models. Ann Surg Treat Res. 2022; 102(6):328-334. PMC: 9204022. DOI: 10.4174/astr.2022.102.6.328. View

Maruthappu M, Gilbert B, El-Harasis M, Nagendran M, McCulloch P, Duclos A . The influence of volume and experience on individual surgical performance: a systematic review. Ann Surg. 2014; 261(4):642-7. DOI: 10.1097/SLA.0000000000000852. View

Schmidt C, Turrini O, Parikh P, House M, Zyromski N, Nakeeb A . Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010; 145(7):634-40. DOI: 10.1001/archsurg.2010.118. View

Tseng J, Pisters P, Lee J, Wang H, Gomez H, Sun C . The learning curve in pancreatic surgery. Surgery. 2007; 141(5):694-701. DOI: 10.1016/j.surg.2007.04.001. View

Giulianotti P, Mangano A, Bustos R, Gheza F, Fernandes E, Masrur M . Operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique : Lessons learned since the first worldwide RPD performed in the year 2001. Surg Endosc. 2018; 32(10):4329-4336. PMC: 6132886. DOI: 10.1007/s00464-018-6228-7. View

Hogg M, Zenati M, Novak S, Chen Y, Jun Y, Steve J . Grading of Surgeon Technical Performance Predicts Postoperative Pancreatic Fistula for Pancreaticoduodenectomy Independent of Patient-related Variables. Ann Surg. 2016; 264(3):482-91. DOI: 10.1097/SLA.0000000000001862. View

Mazzola M, Giani A, Crippa J, Morini L, Zironda A, Bertoglio C . Totally laparoscopic versus open pancreaticoduodenectomy: A propensity score matching analysis of short-term outcomes. Eur J Surg Oncol. 2020; 47(3 Pt B):674-680. DOI: 10.1016/j.ejso.2020.10.036. View

Mazzola M, Giani A, Crippa J, Morini L, Zironda A, Bertoglio C . Totally Laparoscopic Pancreaticoduodenectomy: Comparison Between Early and Late Phase of an Initial Single-Center Learning Curve. Indian J Surg Oncol. 2022; 12(4):688-698. PMC: 8764002. DOI: 10.1007/s13193-021-01422-5. View

Mazzola M, Calcagno P, Giani A, Maspero M, Bertoglio C, De Martini P . Is routine CT scan after pancreaticoduodenectomy a useful tool in the early detection of complications? A single center retrospective analysis. Langenbecks Arch Surg. 2022; 407(7):2801-2810. DOI: 10.1007/s00423-022-02599-1. View

10.

Callery M, Pratt W, Kent T, Chaikof E, Vollmer Jr C . A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2012; 216(1):1-14. DOI: 10.1016/j.jamcollsurg.2012.09.002. View

11.

Mazzola M, Morini L, Crippa J, Maspero M, Zironda A, Giani A . Totally Laparoscopic Pancreaticoduodenectomy: Technical Notes. Chirurgia (Bucur). 2020; 115(3):385-393. DOI: 10.21614/chirurgia.115.3.385. View

12.

Clavien P, Barkun J, De Oliveira M, Vauthey J, Dindo D, Schulick R . The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2):187-96. DOI: 10.1097/SLA.0b013e3181b13ca2. View

13.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M . The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017; 161(3):584-591. DOI: 10.1016/j.surg.2016.11.014. View

14.

Wente M, Veit J, Bassi C, Dervenis C, Fingerhut A, Gouma D . Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007; 142(1):20-5. DOI: 10.1016/j.surg.2007.02.001. View

15.

Wente M, Bassi C, Dervenis C, Fingerhut A, Gouma D, Izbicki J . Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142(5):761-8. DOI: 10.1016/j.surg.2007.05.005. View

16.

Shrikhande S, Sivasanker M, Vollmer C, Friess H, Besselink M, Fingerhut A . Pancreatic anastomosis after pancreatoduodenectomy: A position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2016; 161(5):1221-1234. DOI: 10.1016/j.surg.2016.11.021. View

17.

Marchegiani G, Bassi C . Prevention, prediction, and mitigation of postoperative pancreatic fistula. Br J Surg. 2021; 108(6):602-604. DOI: 10.1093/bjs/znab125. View

18.

McMillan M, Malleo G, Bassi C, Sprys M, Vollmer Jr C . Defining the practice of pancreatoduodenectomy around the world. HPB (Oxford). 2015; 17(12):1145-54. PMC: 4644368. DOI: 10.1111/hpb.12475. View

19.

Gouma D, van Geenen R, van Gulik T, de Haan R, de Wit L, Busch O . Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000; 232(6):786-95. PMC: 1421271. DOI: 10.1097/00000658-200012000-00007. View

20.

Kennedy G, McMillan M, Maggino L, Sprys M, Vollmer Jr C . Surgical experience and the practice of pancreatoduodenectomy. Surgery. 2017; 162(4):812-822. DOI: 10.1016/j.surg.2017.06.021. View