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Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Pancreaticoduodenectomy: Result of a Propensity Score Matching

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Delayed gastric emptying (DGE) is one of the most common morbidities of pancreaticoduodenectomy (PD). The aim of this study was to clarify whether the incidence of DGE can be reduced by side-to-side gastric greater curvature-to-jejunal anastomosis in subtotal stomach-preserving pancreaticoduodenectomy (SSPPD).

Methods

The clinical data of 253 patients who had undergone PD were examined. Of a total of 188 patients who had undergone SSPPD, a gastrojejunostomy (GJ) was performed with end-to-side anastomosis in 87 patients (SSPPD-ETS group), and a GJ was performed with a greater curvature side-to-jejunal side anastomosis in 101 patients (SSPPD-STS group). After propensity score matching, the matched cohort consisted of 74 patients in each group. The postoperative data were evaluated according to the International Study Group of Pancreatic Surgery grade of DGE.

Results

The total incidence of DGE was 9.4% in the SSPPD-ETS group and 4% in the SSPPD-STS group, with no significant difference (p = 0.1902). A significant difference was observed between the two groups in the incidence of DGE grade C (p = 0.0426).

Conclusions

The incidence of total DGE was not reduced statistically in the STS group compared with the ETS group, but reduced DGE grade C. Side-to-side anastomosis might be associated with a reduced incidence of DGE grade C.

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References

  1. Lermite E, Pessaux P, Brehant O, Teyssedou C, Pelletier I, Etienne S, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg. 2007;204:588–96.

    Article  PubMed  Google Scholar 

  2. Hackert T, Hinz U, Hartwig W, Strobel O, Fritz S, Schneider L, et al. Pylorus resection in partial pancreaticoduodenectomy: impact on delayed gastric emptying. American journal of surgery 2013;206:296–9.

    Article  PubMed  Google Scholar 

  3. Qu H, Sun GR, Zhou SQ, He QS. Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis. Eur J Surg Oncol 2013;39:213–23.

    Article  CAS  PubMed  Google Scholar 

  4. Eisenberg JD, Rosato EL, Lavu H, Yeo CJ, Winter JM. Delayed gastric emptying after pancreaticoduodenectomy: An analysis of risk factors and cost. Journal of gastrointestinal surgery. 2015;19:1572–80.

    Article  PubMed  Google Scholar 

  5. Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, et al. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg 2011;253:495–501.

    Article  PubMed  Google Scholar 

  6. Fujii T, Kanda M, Kodera Y, Nagai S, Sahin TT, Hayashi M, et al. Preservation of the pyloric ring has little value in surgery for pancreatic head cancer: a comparative study comparing three surgical procedures. Ann Surgical Oncol 2012;19:176–83.

    Article  Google Scholar 

  7. Kurahara H, Takao S, Shinchi H, Mataki Y, Maemura K, Sakoda M, et al. Subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) prevents postoperative delayed gastric emptying. Journal of surgical oncology 2010;102:615–9.

    Article  PubMed  Google Scholar 

  8. Nanashima A, Abo T, Sumida Y, Tobinaga S, Nonaka T, Takeshita H, et al. Comparison of results between pylorus-preserving pancreaticoduodenectomy and subtotal stomach-preserving pancreaticoduodenectomy: report at a single cancer institute. Hepato-gastroenterology 2013;60:1182–8.

    CAS  PubMed  Google Scholar 

  9. Matsumoto I, Shinzeki M, Asari S, Goto T, Shirakawa S, Ajiki T, et al. A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status. Journal of surgical oncology 2014;109:690–6.

    Article  PubMed  Google Scholar 

  10. Akizuki E, Kimura Y, Nobuoka T, Imamura M, Nishidate T, Mizuguchi T, et al. Prospective nonrandomized comparison between pylorus-preserving and subtotal stomach-preserving pancreaticoduodenectomy from the perspectives of DGE occurrence and postoperative digestive functions. Journal of gastrointestinal surgery 2008;12:1185–92.

    Article  PubMed  Google Scholar 

  11. Nakamura T, Ambo Y, Noji T, Okada N, Takada M, Shimizu T, et al. Reduction of the incidence of delayed gastric emptying in side-to-side gastrojejunostomy in subtotal stomach-preserving pancreaticoduodenectomy. Journal of gastrointestinal surgery 2015;19:1425–32.

    Article  PubMed  Google Scholar 

  12. Sahora K, Morales-Oyarvide V, Thayer SP, Ferrone CR, Warshaw AL, Lillemoe KD, et al. The effect of antecolic versus retrocolic reconstruction on delayed gastric emptying after classic non-pylorus-preserving pancreaticoduodenectomy. American journal of surgery 2015;209:1028–35.

    Article  PubMed  Google Scholar 

  13. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761–8.

    Article  PubMed  Google Scholar 

  14. Hayashibe A, Kameyama M, Shinbo M, Makimoto S. The surgical procedure and clinical results of subtotal stomach preserving pancreaticoduodenectomy (SSPPD) in comparison with pylorus preserving pancreaticoduodenectomy (PPPD). Journal of surgical oncology 2007;95:106–9.

    Article  PubMed  Google Scholar 

  15. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.

    Article  PubMed  Google Scholar 

  16. Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Annals of surgery 2006;243:316–20.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sugiyama M, Abe N, Ueki H, Masaki T, Mori T, Atomi Y. A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. American journal of surgery 2004;187:743–6.

    Article  PubMed  Google Scholar 

  18. Hartel M, Wente MN, Hinz U, Kleeff J, Wagner M, Muller MW, et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Archives of surgery 2005;140:1094–9.

    Article  PubMed  Google Scholar 

  19. Manes K, Lytras D, Avgerinos C, Delis S, Dervenis C. Antecolic gastrointestinal reconstruction with pylorus dilatation. Does it improve delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? HPB 2008;10:472–6.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nikfarjam M, Kimchi ET, Gusani NJ, Shah SM, Sehmbey M, Shereef S, et al. A reduction in delayed gastric emptying by classic pancreaticoduodenectomy with an antecolic gastrojejunal anastomosis and a retrogastric omental patch. Journal of Gastrointestinal Surgery 2009;13:1674–82.

    Article  PubMed  Google Scholar 

  21. Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R, et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB 2010;12:610–8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Imamura N, Chijiiwa K, Ohuchida J, Hiyoshi M, Nagano M, Otani K, et al. Prospective randomized clinical trial of a change in gastric emptying and nutritional status after a pylorus-preserving pancreaticoduodenectomy: comparison between an antecolic and a vertical retrocolic duodenojejunostomy. HPB 2014;16:384–94.

    Article  PubMed  Google Scholar 

  23. Imamura M, Kimura Y, Ito T, Kyuno T, Nobuoka T, Mizuguchi T, et al. Effects of antecolic versus retrocolic reconstruction for gastro/duodenojejunostomy on delayed gastric emptying after pancreatoduodenectomy: a systematic review and meta-analysis. The Journal of surgical research 2016;200:147–57.

    Article  PubMed  Google Scholar 

  24. Eshuis WJ, van Eijck CH, Gerhards MF, Coene PP, de Hingh IH, Karsten TM, et al. Antecolic versus retrocolic route of the gastroenteric anastomosis after pancreatoduodenectomy: a randomized controlled trial. Annals of surgery 2014;259:45–51.

    Article  PubMed  Google Scholar 

  25. Joliat GR, Labgaa I, Demartines N, Schafer M, Allemann P. Effect of antecolic versus retrocolic gastroenteric reconstruction after pancreaticoduodenectomy on delayed gastric emptying: A meta-analysis of six randomized controlled trials. Digestive surgery 2016;33:15–25.

    Article  PubMed  Google Scholar 

  26. Huang MQ, Li M, Mao JY, Tian BL. Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis. International journal of surgery 2015;23:75–81.

    Article  PubMed  Google Scholar 

  27. Watanabe Y, Ohtsuka T, Kimura H, Matsunaga T, Tamura K, Ideno N, et al. Braun enteroenterostomy reduces delayed gastric emptying after pylorus-preserving pancreatoduodenectomy: a retrospective review. American journal of surgery 2015;209:369–77.

    Article  PubMed  Google Scholar 

  28. Xu B, Meng H, Qian M, Gu H, Zhou B, Song Z. Braun enteroenterostomy during pancreaticoduodenectomy decreases postoperative delayed gastric emptying. American journal of surgery 2015;209:1036–42.

    Article  PubMed  Google Scholar 

  29. Nikfarjam M, Houli N, Tufail F, Weinberg L, Muralidharan V, Christophi C. Reduction in delayed gastric emptying following non-pylorus preserving pancreaticoduodenectomy by addition of a Braun enteroenterostomy. JOP 2012;13:488–96.

    PubMed  Google Scholar 

  30. Hochwald SN, Grobmyer SR, Hemming AW, Curran E, Bloom DA, Delano M, et al. Braun enteroenterostomy is associated with reduced delayed gastric emptying and early resumption of oral feeding following pancreaticoduodenectomy. Journal of surgical oncology 2010;101:351–5.

    PubMed  Google Scholar 

  31. Masui T, Doi R, Kawaguchi Y, Uemoto S. Delayed gastric emptying improved by straight stomach reconstruction with twisted anastomosis to the jejunum after pylorus-preserving pancreaticoduodenectomy (PPPD) in 118 consecutive patients at a single institution. Surgery today 2012;42:441–6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N-15 W-7, Sapporo, 060-8638, Japan

    Akio Tsutaho, Toru Nakamura, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Takehiro Noji, Yoshitsugu Nakanishi, Kimitaka Tanaka, Soichi Murakami, Yo Kurashima, Yuma Ebihara, Toshiaki Shichinohe & Satoshi Hirano

  2. Department of Biostatistics, Hokkaido University Graduate School of Medicine, N-15 W-7, Sapporo, 060-8638, Japan

    Yoichi M. Ito

Authors
  1. Akio Tsutaho
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  2. Toru Nakamura
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Contributions

Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work: Akio Tsutaho, Toru Nakamura, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Takehiro Noji, Yoshitsugu Nakanishi, Kimitaka Tanaka, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Toshiaki Shichinohe, Yoichi M Ito.

Drafting the work or revising it critically for important intellectual content: Akio Tsutaho, Toru Nakamura, Satoshi Hirano

Final approval of the version to be published: Akio Tsutaho, Toru Nakamura, Satoshi Hirano

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Akio Tsutaho, Toru Nakamura, Satoshi Hirano

Corresponding author

Correspondence to Toru Nakamura.

Ethics declarations

This study was conducted in accordance with the ethical standards of the Committee on Human Experimentation of our institution, and the study was approved by the Institutional Review Board of Hokkaido University Hospital (No. 016-0395).

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Tsutaho, A., Nakamura, T., Asano, T. et al. Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Pancreaticoduodenectomy: Result of a Propensity Score Matching. J Gastrointest Surg 21, 1635–1642 (2017). https://doi.org/10.1007/s11605-017-3540-9

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  • DOI: https://doi.org/10.1007/s11605-017-3540-9

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