|
|
Back to 2017 Posters
COMPARISON OF LONG-TERM PANCREATIC EXOCRINE FUNCTIONS OF PANCREATICOJEJUNOSTOMY AND PANCREATICOGASTROSTOMY AFTER PANCREATICODUODENECTOMY: A DUAL-CENTER PROSPECTIVE COHORT STUDY
Kenichiro Uemura*3, Keisuke Okano3, Seiko Hirono2, Naoya Nakagawa3, Naru Kondo3, Manabu Kawai2, Ken-ichi Okada2, Motoki Miyazawa2, Atsushi Shimizu2, Yuji Kitahata2, Eisuke Hida4, Taijiro Sueda1, Hiroki Yamaue2, Yoshiaki Murakami1
1Surgery, Hiroshima University, Hiroshima, Japan; 22nd Department of Surgery, Wakayama Medical University, Wakayama, Japan; 3Department of Surgery, Hiroshima University, Hiroshima, Japan; 4Center for Integrated Medical Research, Hiroshima University, Hiroshima, Japan
Backgrounds: Previous studies comparing reconstruction following pancreaticoduodenectomy (PD) by pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) have focused on the short-term morbidity and mortality, however; few studies have demonstrated the long-term pancreatic exocrine function of PJ and PG.
Objectives: We aimed to compare the long-term exocrine function between PJ and PG after PD using the 13C-labeled mixed triglyceride breath test (13CBT) in a dual-center prospective cohort study. (Registration number, UMIN000005758)
Methods: Pancreatic exocrine functions were evaluated before and 12 months after surgery by using the 13CBT, a noninvasive test feasible in the outpatient setting. Primary endpoint of the study was the rate of pancreatic exocrine insufficiency (13CBT<5%) at 12 months after the surgery. Secondary endpoints were the long-term nutritional statuses, endocrine functions, and morphological change of remnant pancreas. Propensity score matching was used to adjust for differences in baseline characteristics.
Results: Of 328 patients recruited (175 PJ, 153 PG), 217 patients (108 PJ, 109 PG) had evaluations at 12 months after the surgery and included in the final analysis. In the original cohort, the PG group contained more patients with preoperative chemotherapy, hard pancreatic texture, and larger size of main pancreatic duct. After propensity score matching, 160 patients (80 PJ, 80 PG) were selected, and the baseline data were similar in the matched groups. Comparisons of the PJ and PG groups at 12 months after the surgery in the matched population revealed pancreatic exocrine insufficiency rates of 37 and 53% (P=0.017) respectively, diameter of pancreatic duct of 2.4 and 3.4mm (P<0.001), serum albumin levels of 4.2 and 4.1 g/dl (P=0.775), lymphocyte counts levels of 1490 and 1400/mm3 (P=0.255), HbA1C levels of 5.8 and 5.8% (P=0.859), pancreatic enzyme replacement therapy rates of 78 and 65% (P=0.077), and use of antidiarrheal drug rates of 10 and 10% (P=1.000).
Conclusion: PJ reconstruction after PD is superior to PG in terms of long-term pancreatic exocrine function of remnant pancreas, although nutritional status and endocrine functions are almost similar between the two groups in this setting.
Back to 2017 Posters
|
