Modified duct-to-mucosa versus conventional pancreaticoenterostomy for pancreaticoduodenectomy: a retrospective cohort study based on propensity score matching analysis.
BACKGROUND
Clinically relevant postoperative pancreatic fistula (CR-POPF) remains the most common neopathy after pancreatoduodenectomy (PD). An ideal pancreaticoenterostomy (PE) which can effectively reduce the incidence of CR-POPF and its potential neopathy is needed. We aimed to assess the efficacy of our modified duct-to-mucosa PE in the PD.


METHOD
From January 2011 to December 2017, 233 consecutive patients with PD were retrospectively included from Shenzhen People's Hospital. After propensity score matching (PSM), there were 82 patients in both the modified duct-to-mucosa PE group (group A) and the conventional end-to-side inserting PE group (group B), respectively. The clinical course and the incidence of postoperative neopathy were compared between groups. Logistic regression method was utilized to analyze the association between PE approach and CR-POPF.


RESULTS
The PE time was shorter in group A (9.3 ± 1.8 min vs. 21.5 ± 2.8 min, P < 0.001). The group A had significantly lower incidence of severe neopathy (Clavien-Dindo grade > II) [7.3% (5/82) vs. 17.1% (14/82), P = 0.028] and incidence of CR-POPF [1.2% (1/82) vs. 19.5% (12/82), P < 0.001] than the group B. Our modified duct-to-mucosa PE technique was associated with a reduced risk for CR-POPF (OR, 0.11 [95% CI, 0.02-0.57]; P = 0.009) as compared with the conventional end-to-side inserting PE.


CONCLUSION
Compared with conventional end-to-side inserting PE, our modified duct-to-mucosa PE technique can effectively reduce the incidences of postoperative neopathy and CR-POPF.


TRIAL REGISTRATION
Researchregistry3877 . Registered 24 March 2018. Retrospectively registered.
['Wu|Tianchong|T|', 'Guo|Yuehua|Y|', 'Bi|Jiangang|J|', 'Liu|Shuwang|S|', 'Guo|Yusheng|Y|', 'Bao|Shiyun|S|http://orcid.org/0000-0003-2941-9043']
D000368:Aged D001650:Bile Duct Neoplasms D021441:Carcinoma, Pancreatic Ductal D005260:Female D005500:Follow-Up Studies D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D009092:Mucous Membrane D010190:Pancreatic Neoplasms D016577:Pancreaticoduodenectomy D010193:Pancreaticojejunostomy D011183:Postoperative Complications D011379:Prognosis D057216:Propensity Score D012189:Retrospective Studies D012307:Risk Factors
Pancreaticoenterostomy Pancreaticoduodenectomy Postoperative pancreatic fistula