HYPOTHESIS: Roux-en-Y reconstruction (RYR) is associated with a reduction in morbidity and mortality associated with pancreatic anastomotic failure after pancreaticoduodenectomy compared with conventional loop reconstruction (CLR). DESIGN: Retrospective study of patients from 1991 to 2006. SETTING: Tertiary care center. PATIENTS: Records of patients undergoing CLR (n = 588) and patients undergoing RYR (n = 112) between February 1, 1991, and June 30, 2006, for pancreatic ductal adenocarcinoma at a single institution were retrospectively reviewed and compared. MAIN OUTCOME MEASURES: Perioperative outcome and mortality were compared for patients who underwent RYR compared with those who underwent CLR. RESULTS: Overall, both groups required a similar rate of postoperative interventional radiology procedures (CLR, 6.8%; RYR, 9.8%; P = .24) and subsequent operations (CLR, 6.9%; RYR, 9.1%; P = .62). No significant difference was found in the rate of overall postoperative mortality (CLR, 2.6%; RYR, 0.9%; P = .49). The overall rate of pancreatic anastomotic failure was 7.2%, and pancreatic anastomotic failure was associated with a 6% mortality rate. Among patients who developed pancreatic anastomotic failure, no significant difference was seen between CLR (n = 32) and RYR (n = 16) in length of hospital stay (18 vs 19 days; P = .98) or postoperative mortality (3 patients [9.4%] vs none [0%]; P = .54). CONCLUSION: We found that RYR is not associated with a reduction in morbidity after pancreaticoduodenectomy for pancreatic adenocarcinoma compared with CLR, even among patients who develop pancreatic anastomotic failure.
HYPOTHESIS: Roux-en-Y reconstruction (RYR) is associated with a reduction in morbidity and mortality associated with pancreatic anastomotic failure after pancreaticoduodenectomy compared with conventional loop reconstruction (CLR). DESIGN: Retrospective study of patients from 1991 to 2006. SETTING: Tertiary care center. PATIENTS: Records of patients undergoing CLR (n = 588) and patients undergoing RYR (n = 112) between February 1, 1991, and June 30, 2006, for pancreatic ductal adenocarcinoma at a single institution were retrospectively reviewed and compared. MAIN OUTCOME MEASURES: Perioperative outcome and mortality were compared for patients who underwent RYR compared with those who underwent CLR. RESULTS: Overall, both groups required a similar rate of postoperative interventional radiology procedures (CLR, 6.8%; RYR, 9.8%; P = .24) and subsequent operations (CLR, 6.9%; RYR, 9.1%; P = .62). No significant difference was found in the rate of overall postoperative mortality (CLR, 2.6%; RYR, 0.9%; P = .49). The overall rate of pancreatic anastomotic failure was 7.2%, and pancreatic anastomotic failure was associated with a 6% mortality rate. Among patients who developed pancreatic anastomotic failure, no significant difference was seen between CLR (n = 32) and RYR (n = 16) in length of hospital stay (18 vs 19 days; P = .98) or postoperative mortality (3 patients [9.4%] vs none [0%]; P = .54). CONCLUSION: We found that RYR is not associated with a reduction in morbidity after pancreaticoduodenectomy for pancreatic adenocarcinoma compared with CLR, even among patients who develop pancreatic anastomotic failure.
Authors: Faik G Uzunoglu; Matthias Reeh; Romy Wollstein; Nathaniel Melling; Daniel Perez; Yogesh K Vashist; Dean Bogoevski; Jakob R Izbicki; Maximilian Bockhorn Journal: World J Surg Date: 2014-12 Impact factor: 3.352
Authors: Thuy B Tran; David J Worhunsky; Malcolm H Squires; Linda X Jin; Gaya Spolverato; Konstantinos I Votanopoulos; Clifford S Cho; Sharon M Weber; Carl Schmidt; Edward A Levine; Mark Bloomston; Ryan C Fields; Timothy M Pawlik; Shishir K Maithel; Jeffrey A Norton; George A Poultsides Journal: Gastric Cancer Date: 2015-09-23 Impact factor: 7.370