SSAT - Roux-en-Y Drainage of the Pancreatic Stump by Nonstented Duct-to-Mucosa Anastomosis Reduced the Amylase Level in the Drainage Fluid After Distal Pancreatectomy With en-bloc Celiac Axis Resection

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Roux-en-Y Drainage of the Pancreatic Stump by Nonstented Duct-to-Mucosa Anastomosis Reduced the Amylase Level in the Drainage Fluid After Distal Pancreatectomy With en-bloc Celiac Axis Resection
Ken-Ichi Okada^*, Masaji Tani, Manabu Kawai, Seiko Hirono, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Masaki Ueno, Shinya Hayami, Yoshinobu Shigekawa, Hiroki Yamaue
Second Department of Surgery, Wakayama Medical University Hospital, Wakayama, Japan

Background. The pancreatic fistula is a fatal complication especially in distal pancreatectomy with en-bloc celiac axis resection (DP-CAR). Among the literatures about the management of the pancreatic stump after distal pancreatectomy, the most attractive method with low incidence of pancreatic fistula was reported in pancreaticoenteric anastomosis.
Methods. Twenty-six consecutive patients who underwent DP-CAR between April 2008 and August 2012 were reviewed retrospectively. The first 13 consecutive patients underwent DP-CAR with no anastomosis, and the subsequent 13 consecutive patients with Roux-en-Y pancreatico-jejunostomy (PJ) by duct-to-mucosa fashion.
Results. Median operation time for DP-CAR with PJ was 382 compared to 366 minutes for DP-CAR with no anastomosis (p=0.840). Clinically significant pancreatic fistula (ISGPF [The International Study Group on Pancreatic Fistula] classification Grade B/C) occurred in 2 patients (15.4%) with PJ and 5 patients (38.5%) with no anastomosis (p=0.189). The median amylase level in the drainage fluid were decreased in patients with PJ compared to those in patients with no anastomosis at all time points, 315/589 (IU/L) on postoperative day (POD) 1 (p=0.336), 121/286 (IU/L) on POD 3 (p=0.050), and 52/247 (IU/L) on POD4 (p=0.044), respectively. There were no significant differences in regard to mortality and morbidity rates between the groups.
Conclusion. Roux-en-Y drainage of the pancreatic stump by nonstented duct-to-mucosa anastomosis reduced the amylase level in the drainage fluid after DP-CAR (Journal of Hepato-Biliary-Pancreatic Sciences In Press.). We are proceeding to examine the evidence of the present study in a multicenter, randomized controlled trial for distal pancreatectomy patients (ClinicalTrials.gov NCT01384617).

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