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Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery

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Pancreatodigestive anastomosis: the key to a favorable outcome of pancreaticoduodenal resection

https://doi.org/10.16931/1995-5464.2022-3-92-99

Abstract

The paper presents the results of various studies and meta-analyses which focus on assessing the frequency of formation of clinically significant pancreatic fistulas in various types of pancreatic-digestive anastomoses. Pancreatodigestive anastomosis is not an independent predictive factor of pancreatic complications. None of the modern types of pancreatodigestive anastomosis has proved its superiority. The choice of the pancreatodigestive anastomosis method is based on the correct selection of the organ with which the pancreatic stump is connected and the surgeon’s experience and skill in forming the anastomosis.

About the Authors

A. G. Kotelnikov
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Aleksey G. Kotelnikov – Doct. of Sci. (Med.), Professor, Leading Researcher of the Oncology Department of Surgical Treatment Methods No.7

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



Yu. I. Patyutko
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Yuri I. Patyutko – Doct. of Sci. (Med.), Professor, Chief Researcher, Oncology Department of Surgical Treatment Methods No.7

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



D. V. Podluzhny
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Danil V. Podluzhnyi – Cand. of Sci. (Med.), Head of the Oncology Department of Surgical Treatment Methods No.7

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



M. S. Saakyan
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Margarita S. Saakyan – Postgraduate Student of the Oncology Department of Surgical Treatment Methods No.7

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



N. E. Kudashkin
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Nikolai E. Kudashkin – Cand. of Sci. (Med.), Senior Researcher of the Oncology Department of Surgical Treatment Methods No.7

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



A. N. Polyakov
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Alexander N. Polyakov – Cand. of Sci. (Med.), Senior Researcher of the Oncology Department of Surgical Treatment Methods No.7

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



P. A. Tikhonov
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Pavel A. Tikhonov – Physician of the Oncology Department of Surgical Treatment Methods No.7

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



E. A. Suleimanov
Peoples’ Friendship University of Russia (RUDN University)
Russian Federation

El’khan A. Suleimanov – Doct. of Sci. (Med.), Professor of the Department of Urology and Surgical Nephrology with a Course of Onco-urology

Miklukho-Maklaya str., Moscow, 117198, Russian Federation



I. S. Stilidi
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation
Russian Federation

Ivan S. Stilidi – Doct. of Sci. (Med.), Professor, Academician of Russian Academy of Sciences, Director

23, Kashirskoe shosse, Moscow, 115478, Russian Federation



References

1. Kawaida H., Kono H., Hosomura N., Amemiya H., Itakura J., Fujii H., Ichikawa D. Surgical techniques and postoperative pancreatic fistula after pancreatic surgery. World J. Gastroenterol. 2019; 25 (28): 3722–3737. https://doi.org/10.3748/wjg.v25.i28.3722

2. Narayanan S., Martin A.N., Turrentine F.E., Bauer T.W., Adams R.B., Zaydfudim V.M. Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J. Surg. Res. 2018; 231: 304–308. https://doi.org/10.1016/j.jss.2018.05.075

3. Kawai M., Yamane H. Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg. Today. 2010; 40 (11): 1011–1017. https://doi.org/10.1007/s00595-009-4245-9

4. Andrianello S., Marchegiani G., Malleo G., Masini G., Balduzzi A., Paiella S., Esposito A., Landoni L., Casetti L., Tuvery M., Salvia R., Bassi C. Pancreaticojejunostomy with externalized stent vs pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis (a singlecenter, phase 3, randomized clinical trial). JAMA Surg. 2020; 155 (4): 313–321. https://doi.org/10.1001/jamasurg.2019.6035

5. Liu Q.Y., Zhang W.Z., Xia H.T., Leng J.-J., Wan T., Liang B., Yang T., Dong J.-H. Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy. World J. Gastroenterol. 2014; 20 (46): 17491–17497. https://doi.org/10.3748/wjg.v20.i46.17491

6. Kriger A.G. Khirurgicheskaya pankreatologiya [Surgical pancreatology]. Moscow: RIA “Vneshtorgizdat”, 2021. 332 p. (In Russian)

7. Bassi C., Marchegiani G., Dervenis C. The 2016 update of International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017; 161 (3): 584–591. https://doi.org/10.1016/j.surg.2016.11.014

8. Callery M.P., Wande B.P., Kent T.S., Chaikof E.L., Vollmer C.M. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J. Am. Coll. Surg. 2013; 216 (1): 1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002

9. Galchina Yu.S., Kаrmаzаnovsky G.G., Kalinin D.V., Kondratyev E.V., Gorin D.S., Galkin G.V., Kriger A.G. Diagnostic criteria for a “soft” pancreas and their influence on the occurrence of pancreatic fistula after pancreatoduodenal resection. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2020; 25 (2): 113–123. https://doi.org/10.16931/1995-5464.20202113-123 (In Russian)

10. Daamen L.A., Smits F.J., Besselink M.G., Busch O.R., BorelRinkes I.H., van Santvoort H.C., Molenaar I.Q. A webbased overview, systematic review and meta-analysis of pancreatic anastomosis techniques following pancreatoduodenectomy. HPB. 2018; 20 (9): 777–785. https://doi.org/10.1016/j.hpb.2018.03.003

11. Hirono S., Kawai M., Okada K.I., Miyazawa M., Kitahata Y., Hayami S., Ueno M., Yamaue H. Modified Blumgart matress suture versus conventional interrupted suture in pancreaticojejunostomy during pancreaticoduodenectomy (randomized controlled trial). Ann. Surg. 2019; 269 (2): 243–251. https://doi.org/10.1097/SLA.0000000000002802

12. Wang S.-E., Chen S.-C., Shyr B.-U., Shyr Yi-M. Comparison of modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. HPB. 2016; 18 (3): 229–235. https://doi.org/10.1016/j.hpb.2015.09.007

13. Waugh J.M., Clagett O.T. Resection of duodenum and head of pancreas for carcinoma; an analysis of thirty cases. Surgery. 1946; 20: 224–232. PMID: 20994806

14. McKay A., Mackenzie S., Sutherland F.R., Bathe O.F., Doing C., Dort J. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy. Br. J. Surg. 2006; 93 (8): 929–936. https://doi.org/10.1002/bjs.5407

15. Wente M.N., Shrikhande S.V., Muller M.W., Diener M.K., Seiler C.M., Friess H., Markus B.W. Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and metaanalysis. Am. J. Surg. 2007; 193 (2): 171–183. https://doi.org/10.1016/j.amjsurg.2006.10.010

16. He T., Zhao Y., Chen Q., Wang X., Lin H., Han W. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a systematic review and metaanalysis. Dig. Surg. 2013; 30 (1): 56–69. https://doi.org/10.1159/000350901

17. Bassi C., Falconi M., Molinari E., Salvia R., Butturini G., Sartori N., Mantovani W., Pederzoli P. Reconstruction by pancreatico jejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann. Surg. 2005; 242 (6): 767–773. https://doi.org/10.1097/01.sla.0000189124.47589.6d

18. Duffas J.P., Suc B., Msika S., Fourtanier G., Muscari F., Hay J.M., Fingerhut A., Millat B., Radovanowic A., Fagniez P.L. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy. Am. J. Surg. 2005; 189 (6): 720–729. https://doi.org/10.1016/j.amjsurg.2005.03.015

19. Clerveus M., Moranderia-Rivas A., Picazo-Yeste J., Moreno- Sanz C. Pancreaticogastrostomy versus pancreatico jejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. J. Gastrointestinal. Surg. 2014; 18 (9): 1693–1704. https://doi.org/10.1007/s11605-014-2557-6

20. Fernandez-Cruz L., Cosa R., Blanco L., Lopez-Boado M.A., Astudillo E. Pancreatogastrostomy with gastric partition after pylorus preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann. Surg. 2008; 248 (6): 930–938. https://doi.org/10.1097/SLA.0b013e31818fefc7

21. Figueras J., Sabater L., Planellas P., Munoz-Forner E., Lopez- Ben S., Falgueras L., Sala-Palau C., Albiol M., Ortega- Serrano J., Castro-Gutierez E. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br. J. Surg. 2013; 100 (12): 1597–1605. https://doi.org/10.1002/bjs.9252

22. Wellner U.F., Sick O., Olschewski M., Adam U., Hopt U.T., Keck T. Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J. Gastroinest. Surg. 2012; 16 (9): 1686–1695. https://doi.org/10.1007/s11605-012-1940-4

23. Yeo C.J., Cameron J.L., Maher M.M., Sauter P.K., Zahurak M.L., Talamini M.A., Lillemoe K.D., Pitt H.A. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann. Surg. 1995; 222 (4): 580–592. https://doi.org/10.1097/00000658-199510000-00014

24. Topal B., Fieuws S., Aerts R., Weerts J., Feryn T., Roeyen G. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruc tion after pancreaticoduodenectomy for pancreatic or periampullarytumours: a multicenter randomized trial. Lancet Oncol. 2013; 14 (7): 655–662. https://doi.org/10.1016/S1470-2045(13)70126-8

25. El Nakeeb A., Hamdy S., Sultan A.M., Salah T., Askr W., Ezzat H. Isolated Roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study. HPB. 2014; 16 (8): 713–722. https://doi.org/10.1111/hpb.12210

26. Keck T., Wellner U.F., Bahra M., Klein F., Sick O., Niedergethmann M. Pancreatogastrostomy versus pancreatojejunostomy for reconstruction after pancreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and longterm results of a multicenter randomized controlled trial. Ann. Surg. 2016; 263 (3): 440–449. https://doi.org/10.1097/SLA.0000000000001240

27. Warren K.W., Cattell R.B. Basic techniques in pancreatic surgery. Surg. Clin. North. Am. 1956; 36 (3): 707–724. https://doi.org/10.1016/s0039-6109(16)34896-4

28. Berger A.C., Howard T.J., Kennedy E.P., Sauter P.K., Bower- Cherry M., Dutkevitch S. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate pancreatic fistula? A randomized, prosrective, dual-institution trial. J. Am. Coll. Surg. 2009; 208 (5): 738–747. https://doi.org/10.1016/j.jamcollsurg.2008.12.031

29. El Nakeeb A., El Hemaly M., Askr W., AbdEllatif M., Hamed H., Elghawalby A. Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study. Int. J. Surg. 2015; 16 (part A): 1–6. https://doi.org/10.1016/j.ijsu.2015.02.002

30. Xu J., Zhang B., Qin Y., Ji S., Xu W., Liu J., Liu C. Papillary-like main pancreatic duct invaginated pancreaticojejunostomy versus duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Surgery. 2015; 158 (5): 1211–1218. https://doi.org/10.1016/j.surg.2015.04.020

31. Bai X., Zhang Q., Gao S., Lou J., Li G., Zhang Y., Ma T., Zhang Y., Xu Y., Liang T. Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy: a prospective, randomized controlled trial from a single surgeon. J. Am. Coll. Surg. 2016; 222 (1): 10–18. https://doi.org/10.1016/j.jamcollsurg.2015.10.003

32. Singh A.N., Pal S., Mangla V., Kilambri R., George J., Dash N.R. Pancreaticojejunostomy: does the technique metter? A randomized trial. J. Surg. Oncol. 2018; 117 (3): 389–396. https://doi.org/10.1002/jso.24873

33. Senda Y., Shimizu Y., Natsume S., Ito S., Ito S., Komori K., Abe T. Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy. Br. J. Surg. 2018; 105 (1): 48–57. https://doi.org/10.1002/bjs.10727

34. Brennan M. Pancreaticojejunostomy. In: Blumgart L.H., Fong Y., eds. Surgery of the liver and biliary tract. 3rd ed., Philadelphia: Saunders, 2000; 3: 1073–1089.

35. Grobmyer S.R., Kooby D., Blumgart L.H., Hochwald S.N. Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. J. Am. Coll. Surg. 2010; 210 (1): 54–59. https://doi.org/10.1016/j.jamcollsurg.2009.09.020

36. Oda T., Hashimoto S., Miyamoto Y., Shimomura O., Fukunaga K., Kohno K., Ohshiro Y., Akashi Y., Enomoto T., Ohkohchi N. The tight adaptation at pancreatic anastomosis without pancrenchymal laceration: an institutional experience in introducing and modifying the new procedure. World J. Surg. 2015; 39 (8): 2014–2022. https://doi.org/10.1007/s00268-015-3075-8

37. Gupta V., Kumar S., Gupta V., Joshi P., Rahul R., Yadav R.K., Dangi A., Chandra A. Blumgarts technique of pancreaticojejunostomy: analysis of safty and outcomes. Hepatobiliary Pancreat. Dis. Int. 2019; 18 (2): 181–187. https://doi.org/10.1016/j.hbpd.2019.01.007

38. Ricci C., Ingaldi C., Alberici L., Pagano N., Mosconi C., Marasco G., Minni F., Casadei R. Blumgart anastomosis after pancreaticoduodenectomy. A comprehensive systematic review, meta-analysis, and meta-regression. World J. Surg. 2021; 45 (6): 1929–1939. https://doi.org/10.1007/s00268-021-06039-х

39. Kakita A., Yoshida M., Takahashi T. History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique. J. Hepat. Pancreat. Surg. 2001; 8 (3): 230–237. https://doi.org/10.1007/s005340170022

40. Halloran C., Neoptolemos J., Palmer D., Jackson R., Platt K., Reddy S., O'Reilly D., Dhanny G., Prachalias A., Menon K., Smith A., Davidson B., Ghaneh P. PANasta Trial: Cattell Warren versus Blumgart techniques of pancreatico-jejunostomy following pancreato-duodenectomy – a randomised double blind multi-centre trial: final trial results. Pancreatology. 2020; 20 (1): S8–S9. https://doi.org/10.1016/j.pan.2020.07.377

41. Patutko Yu.I., Kudashkin N.E., Kotelnikov A.G. Different types of pancreatodigestive anastomoses for pancreatoduodenectomy. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2013; 18 (3): 9–14. (In Russian)


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Kotelnikov A.G., Patyutko Yu.I., Podluzhny D.V., Saakyan M.S., Kudashkin N.E., Polyakov A.N., Tikhonov P.A., Suleimanov E.A., Stilidi I.S. Pancreatodigestive anastomosis: the key to a favorable outcome of pancreaticoduodenal resection. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2022;27(3):92-99. (In Russ.) https://doi.org/10.16931/1995-5464.2022-3-92-99

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ISSN 1995-5464 (Print)
ISSN 2408-9524 (Online)