Ann Surg Treat Res.  2020 Apr;98(4):177-183. 10.4174/astr.2020.98.4.177.

Comparison of clinical outcomes according to the history of previous gastrectomy in patients undergoing pancreatoduodenectomy: a propensity score matching analysis

Affiliations
  • 1Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
Although pancreatoduodenectomy (PD) in patients who have previously undergone gastrectomy is challenging, little is known about the clinical outcomes and the differences compared to those with conventional PD. We collected cases and conducted studies in retrospective review.
Methods
Of the 1,722 patients who underwent PD at Seoul National University Hospital between 2000 and 2014, 49 (2.8%) underwent previous gastrectomy. Clinical outcomes including operation-related factors and postoperative morbidities were analyzed.
Results
Among the 49 patients with curative surgery, 25 patients were male (51.0%) and the mean age was 64.7 years. Gastric cancer was the most frequent cause of previous gastrectomy (93.8%). With one-to-one propensity score matching analysis, lower preoperative body mass index (22.6 kg/m2 vs. 20.8 kg/m2, P = 0.002), higher EBL (390.0 mL vs. 729.5 mL, P = 0.027), and higher transfusion rates (10.2% vs. 36.7%, P = 0.002) were shown in the gastrectomy group. Operation time, postoperative hospital stay, and rate of clinically relevant pancreatic fistula were comparable.
Conclusion
Secondary PD after prior gastrectomy remains challenging, with higher EBL and rate of transfusion. However, when performed by experienced surgeons, the patients with or without previous gastrectomy show comparable postoperative clinical outcomes, such as similar duration of postoperative hospital stay and rate of postoperative pancreatic fistula.

Keyword

Gastrectomy; Pancreatoduodenectomy

Figure

  • Fig. 1 Resection and reconstruction methods used in these patients. (A) STG Billroth I. (B) STG Billroth II. (C) TG with Roux-en-Y esophagojejunostomy. STG, subtotal gastrectomy; BI, Billroth I; BII, Billroth II; TG, total gastrectomy; C-J, choledochojejunostomy; P-J, pancreaticojejunostomy; G-J, gastrojejunostomy; E-J, esophagojejunostomy. Solid red lines indicate resection of the stomach or jejunum; dashed red lines indicate resection of the pancreas.


Cited by  1 articles

Various types of reconstruction after pancreaticoduodenectomy for the patients who underwent all types of gastrectomy: a single-enter experience
Hyun-Jeong Jeon, Hyung-Jun Kwon, Yoon-Jin Hwang, Sang Geol Kim
Ann Surg Treat Res. 2022;102(6):323-327.    doi: 10.4174/astr.2022.102.6.323.


Reference

1. Whipple AO. Observations on radical surgery for lesions of the pancreas. Surg Gynecol Obstet. 1946; 82:623–631. PMID: 20983134.
2. Okano K, Hirao T, Unno M, Fujii T, Yoshitomi H, Suzuki S, et al. Postoperative infectious complications after pancreatic resection. Br J Surg. 2015; 102:1551–1560. PMID: 26387569.
Article
3. Jang JY, Kang MJ, Heo JS, Choi SH, Choi DW, Park SJ, et al. A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer. Ann Surg. 2014; 259:656–664. PMID: 24368638.
Article
4. Bassi C, Falconi M, Salvia R, Mascetta G, Molinari E, Pederzoli P. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Dig Surg. 2001; 18:453–457. PMID: 11799295.
5. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136:E359–E386. PMID: 25220842.
Article
6. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat. 2014; 46:109–123. PMID: 24851102.
Article
7. Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer. 2013; 16:1–27. PMID: 22729699.
Article
8. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011; 29:4387–4393. PMID: 22010012.
Article
9. Lee D, Lee JH, Choi D, Kang CM, Chong JU, Kim SC, et al. Surgical strategy and outcome in patients undergoing pancreaticoduodenectomy after gastric resection: a three-center experience with 39 patients. World J Surg. 2017; 41:552–558. PMID: 27730351.
Article
10. Kawamoto Y, Ome Y, Kouda Y, Saga K, Park T, Kawamoto K. Pancreaticoduodenectomy fol lowing gastrectomy reconstructed with Billroth II or Rouxen-Y method: case series and literature review. Int J Surg Case Rep. 2017; 35:106–109. PMID: 28477562.
11. Doi R, Fujimoto K, Imamura M. Effects of preceding gastrectomy on the outcome of pancreatoduodenectomy. J Gastrointest Surg. 2004; 8:575–579. PMID: 15239994.
12. Nikfarjam M, Staveley-O'Carroll KF, Kimchi ET, Hardacre JM. Pancreaticoduodenectomy in patients with a history of Roux-en Y gastric bypass surgery. JOP. 2009; 10:169–173. PMID: 19287111.
13. Kim SH, Hwang HK, Kang CM, Lee WJ. Pancreatoduodenectomy in patients with periampullary cancer after radical subtotal gastrectomy for gastric cancer. Am Surg. 2012; 78:E164–E167. PMID: 22524749.
Article
14. Bechi P, Dioscoridi L. Reconstructive strategy after pancreaticoduodenectomy in partially gastrectomized patients. JOP. 2015; 16:198–200. PMID: 25791557.
15. Yun S, Choi D. Pancreaticoduodenectomy in patients with a history of total gastrectomy for stomach cancers. Int Surg. 2014; 99:71–76. PMID: 24444273.
Article
16. Yokoyama S, Sekioka A, Ueno K, Higashide Y, Okishio Y, Kawaguchi N, et al. Pancreaticoduodenectomy following total gastrectomy: a case report and literature review. World J Gastroenterol. 2014; 20:2721–2724. PMID: 24627609.
Article
17. Oida T, Mimatsu K, Kawasaki A, Kano H, Kuboi Y, Amano S. Reconstruction following pancreaticoduodenectomy for patients who have previously undergone partial gastrectomy. Hepatogastroenterology. 2010; 57:149–154. PMID: 20422892.
18. Child CG. Pancreaticojejunostomy and other problems associated with the surgical management of carcinoma involving the head of the pancreas: report of five additional cases of radical pancreaticoduodenectomy. Ann Surg. 1944; 119:845–855. PMID: 17858411.
Article
19. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138:8–13. PMID: 16003309.
Article
20. Canto MI, Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology. 2012; 142:796–804. PMID: 22245846.
Article
21. Del Chiaro M, Verbeke CS, Kartalis N, Pozzi Mucelli R, Gustafsson P, Hansson J, et al. Short-term results of a magnetic resonance imaging-based swedish screening program for individuals at risk for pancreatic cancer. JAMA Surg. 2015; 150:512–518. PMID: 25853369.
Article
22. Tol JA, Brosens LA, van Dieren S, van Gulik TM, Busch OR, Besselink MG, et al. Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg. 2015; 102:237–245. PMID: 25529117.
Article
23. Lee LS, Lee SH, Kang CM. Reconstruction after pancreatoduodenectomy in patients with periampullary cancer following radical total gastrectomy for gastric cancer. JOP. 2015; 16:405–407.
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr