Residual pancreatic function after pancreaticoduodenectomy is better preserved with pancreaticojejunostomy than pancreaticogastrostomy: A long-term analysis
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.
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ARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Erickson, J. Alan
Aldeen, William E.
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ARUP Labs, Microbial Antigen Detect Tech Sect, Salt Lake City, UT 84108 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Aldeen, William E.
Grenache, David G.
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ARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Univ Utah, Hlth Sci Ctr, Dept Pathol, Salt Lake City, UT 84132 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Grenache, David G.
Ashwood, Edward R.
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ARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Univ Utah, Hlth Sci Ctr, Dept Pathol, Salt Lake City, UT 84132 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
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Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea
Jang, JY
Kim, SW
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Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea
Kim, SW
Park, SJ
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Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea
Park, SJ
Park, YH
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Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea
机构:
ARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Erickson, J. Alan
Aldeen, William E.
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h-index: 0
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ARUP Labs, Microbial Antigen Detect Tech Sect, Salt Lake City, UT 84108 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Aldeen, William E.
Grenache, David G.
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h-index: 0
机构:
ARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Univ Utah, Hlth Sci Ctr, Dept Pathol, Salt Lake City, UT 84132 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Grenache, David G.
Ashwood, Edward R.
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h-index: 0
机构:
ARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
Univ Utah, Hlth Sci Ctr, Dept Pathol, Salt Lake City, UT 84132 USAARUP Labs, ARUP Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA
机构:
Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea
Jang, JY
Kim, SW
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Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea
Kim, SW
Park, SJ
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h-index: 0
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Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea
Park, SJ
Park, YH
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Seoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South KoreaSeoul Natl Univ, Coll Med, Dept Surg, Chongno Ku, Seoul 110744, South Korea