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Pancreatojejunostomy: standing on the shoulders of giants. A single centre retrospective analysis

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Abstract

Gaining experience in pancreatic surgery could be demanding especially when minimally invasive approach is used. Pancreatojejunostomy (PJ) is one of the most critical steps during pancreatoduodenectomy (PD). Our aim was to investigate the impact of a surgeon's experience in performing PJ, especially in a subgroup of patients undergoing laparoscopic PD (LPD). Data of consecutive patients undergoing PD from 2017 to 2022 were prospectively collected and retrospectively analyzed. Patients were divided into two groups: M group included patients in which PJ was performed by an experienced surgeon, D group included those receiving PJ by a less experienced one. The groups were compared in terms of postoperative outcomes. 187 patients were selected (157 in group M and 30 in group D). The cohorts differed in terms of median age (68 vs 74 years, p = 0.016), and previous abdominal surgery (41.4% vs 66.7%, p = 0.011), while no difference was found regarding risk of postoperative pancreatic fistula (POPF). The groups did not differ in terms of surgical outcomes. POPF rate was 15.9% and 10% in the M and D group (p = 0.578), respectively. Among patients undergoing laparoscopic PJ POPF rate was 16.0% and 17.7% in the M and D group (p = 0.867), respectively, without difference. No difference was found in terms of POPF in patients undergoing PD independently from the surgeon who performed the PJ, even during LPD. Moderate/high FRS, BMI > 30 kg/m2 and male sex, but not the surgeon who performed the PJ anastomosis, were independent predictors of POPF.

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Authors and Affiliations

  1. Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162, Milan, Italy

    Michele Mazzola, Alessandro Giani, Pietro Calcagno, Antonio Benedetti, Andrea Zironda, Monica Gualtierotti, Paolo De Martini & Giovanni Ferrari

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  1. Michele Mazzola
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  2. Alessandro Giani
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  3. Pietro Calcagno
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  4. Antonio Benedetti
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  5. Andrea Zironda
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  6. Monica Gualtierotti
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  7. Paolo De Martini
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  8. Giovanni Ferrari
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by PC, AZ, AB, AG and PM. The first draft of the manuscript was written by MM and AG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Michele Mazzola.

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Mazzola, M., Giani, A., Calcagno, P. et al. Pancreatojejunostomy: standing on the shoulders of giants. A single centre retrospective analysis. Updates Surg 76, 97–106 (2024). https://doi.org/10.1007/s13304-023-01643-z

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  • DOI: https://doi.org/10.1007/s13304-023-01643-z

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