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

• Kim JR
• Kwon W
• Chang J
• Jang JY
• Kim SW

• KMID: 2500817
• DOI: http://doi.org/10.4174/astr.2020.98.4.177

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.

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