Residual pancreatic function after pancreaticoduodenectomy is better preserved with pancreaticojejunostomy than pancreaticogastrostomy: A long-term analysis

被引:20
作者
Benini, Luigi [1 ]
Gabbrielli, Armando [1 ]
Cristofori, Chiara [1 ]
Amodio, Antonio [1 ]
Butturini, Giovanni [2 ]
Cardobi, Nicole [3 ]
Sozzi, Carlo [3 ]
Frulloni, Luca [1 ]
Mucelli, Roberto Pozzi [3 ]
Crino, Stefano [1 ]
Bassi, Claudio [2 ]
Marchegiani, Giovanni [2 ]
Andrianello, Stefano [2 ]
Malleo, Giuseppe [2 ]
Salvia, Roberto [2 ]
机构
[1] Univ Verona Hosp Trust, Pancreas Inst, Gastroenterol B, Dept Med, Verona, Italy
[2] Univ Verona Hosp Trust, Pancreas Inst, Gen & Pancreat Surg, Verona, Italy
[3] Univ Verona Hosp Trust, Pancreas Inst, Dept Diag & Pathol, Radiol, Verona, Italy
关键词
Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancreaticogastrostomy; Diabetes; Exocrine insufficiency; QUALITY-OF-LIFE; EXOCRINE INSUFFICIENCY; DOUBLE-BLIND; SURGERY; PANCREATOGASTROSTOMY; ELASTASE-1; QLQ-C30; CREON;
D O I
10.1016/j.pan.2019.04.004
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Pancreatico-enteric anastomosis after pancreaticoduodenectomy can be performed using either a pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG). Differences in surgical outcomes are still a matter of debate, and less is known about long-term functional outcomes. Methods: Twelve years after the conclusion of a comparative study evaluating the surgical outcomes of PJ and PG (Bassi et al., Ann Surg 2005), available patients underwent morphological and functional pancreatic assessment: pancreatic volume and duct diameter measured by MRI, impaired secretion after secretin, fecal fat, fecal elastase-1 (FE-1), serum vitamin D and endocrine function. Quality of life and symptom scores were evaluated with the EORTC QLQ-C30 questionnaire. Results: Only 34 patients were available for assessment. No differences were found in terms of BMI variation, endocrine function, quality of life or symptoms. Exocrine function was more severely impaired after PG than after PJ (fecal fats 26.6 +/- 4.1 vs 18.2 +/- 3.6 g/day; FE-1 121.4 +/- 6.7 vs 170.2 +/- 25.5 mu g/g, vitamin D 18.1 +/- 1.8 vs. 23.2 +/- 3.1 ng/mL). MRI assessment identified a lower pancreatic volume (26 +/- 3.1 vs. 36 +/- 4.1 cm(3)) and a more dilated pancreatic duct (4.6 +/- 0.92 vs. 2.4 +/- 0.18 mm) in patients with PG compared to those with PJ. Conclusion: Compared to PJ, PG is associated with a more severely impaired exocrine function long-term, but they result similar endocrine function and quality of life. In patients with a long life expectancy, this should be taken into account. (C) 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:595 / 601
页数:7
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