Surgical outcome and survival analysis of pancreaticogastrostomy after pancreaticoduodenectomy: A prospective study in a single institution

Abstract

Mohamed I Kassem, Hany M Elhaddad, Mohamed T Elriwini, Adel A AbuNasr, Gihan Shehata

Background: The definitive reconstructive technique of the pancreatic stump after pancreaticoduodenectomy (PD) differs among centers. Purpose: The purpose of this study was to evaluate the surgical outcome of stented pancreaticogastrostomy (PG) and the long-term survival after PD in a single center.Patients and Methods: A prospective study of stented PG was performed on 152 patients by the same surgical team over a 7-year period from January 2010 to January 2017. In the early postoperative period, patients were examined for morbidity and mortality related to the procedure. After that, patients were followed up for long-term survival. Results: There were 88 men (57.9%) and 64 women (42.1%); with a mean age of 62.6 (35-87) years. Early postoperative complications occurred in 47 patients (30.9%) including five patients with the pancreatic leak. The survival rate at the end of 1 year, 3 and five years were 80%, 58%, and 42% respectively. Univariate and multivariate analysis revealed that longer survival was found in patients with lower tumor grades and stages, CA 19.9 level less than 100 ng/ml, negative R status and in patients not receiving chemotherapy. Conclusion: The present technique with its low morbidity rate approaches the parameters of an ideal pancreatic anastomotic technique after PD. Factors associated with better survival should be considered for the sake of obtaining the best prognosis.