Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.
World J Surg. 2021 Jun;45(6):1845-1852. doi: 10.1007/s00268-021-05998-5. Epub 2021 Feb 16.
The need for pancreaticoduodenectomy (PD) after Roux-en-Y (RY) reconstruction after tumor removal is expected to increase in future, but current studies on outcome are sparse. This surgery is challenging, due to intraabdominal adhesions and/or anatomical changes introduced by the previous abdominal surgery. Here, we investigated the surgical outcomes of PD after RY reconstruction following tumor removal.
We enrolled 283 patients that underwent PD. Surgical outcomes for PD were compared between patients with or without a history of RY reconstruction after tumor removal. Outcomes were also compared between two different surgical procedures for the post-PD reconstruction.
Among 283 patients, 11 had a history of RY reconstruction after tumor removal (3.9%). Among these, RY reconstructions had been performed where the small intestine was anastomosed to a remnant stomach after distal gastrectomy (n = 2), to remnant stomach after proximal gastrectomy (n = 1), to the esophagus after total gastrectomy (n = 6), or to the hepatic duct after extrahepatic bile duct resection (n = 2). Surgical outcomes were not significantly different between cases with and without RY reconstructions. We identified two different reconstruction procedures after removing the periampullary tumor during PD. The surgical outcomes were not significantly different between these two reconstruction groups.
The surgical outcome of PD was not significantly affected by a history of RY reconstruction. Similarly, the type of reconstruction performed during PD did not significantly affect the outcome. These results could be useful when planning PD in patients with a history of RY reconstruction after tumor removal.
在肿瘤切除后行 Roux-en-Y（RY）重建后，预计需要进行胰十二指肠切除术（PD）的情况将会增加，但目前关于该手术结果的研究较少。由于先前腹部手术导致的腹腔内粘连和/或解剖结构改变，该手术具有挑战性。在此，我们研究了肿瘤切除后行 RY 重建后行 PD 的手术结果。
我们纳入了 283 例行 PD 的患者。比较了有和无肿瘤切除后 RY 重建史患者的 PD 手术结果。还比较了 PD 后两种不同重建手术的结果。
在 283 例患者中，有 11 例（3.9%）有肿瘤切除后 RY 重建史。其中，RY 重建术将小肠与远端胃吻合（n=2）、近端胃吻合（n=1）、全胃切除后与食管吻合（n=6）或肝外胆管切除后与肝管吻合（n=2）。有和无 RY 重建史的患者之间的手术结果无显著差异。我们在 PD 期间发现了两种不同的重建方法。这两种重建组之间的手术结果无显著差异。
RY 重建史对 PD 的手术结果没有显著影响。同样，PD 期间进行的重建类型也不会显著影响结果。这些结果对于计划肿瘤切除后行 RY 重建的患者的 PD 手术可能有用。
