Kiguchi Gozo, Sugioka Atsushi, Uchida Yuichiro, Yoshikawa Junichi, Nakauchi Masaya, Kojima Masayuki, Tanahashi Yoshinao, Takahara Takeshi, Yasuda Akira, Suda Koichi, Kato Yutaro, Uyama Ichiro
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
Surg Oncol. 2021 Sep;38:101577. doi: 10.1016/j.suronc.2021.101577. Epub 2021 Apr 9.
Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is technically demanding because of pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) is the most serious complication of MIPD and open pancreaticoduodenectomy (OPD). Contrary to expectations, conventional PJ in MIPD did not improve POPF rate and length of hospital stay. High POPF rates are attributed to technical issues encountered during MIPD, which include motion restriction and insufficient water tightness. Therefore, we developed wrapping double-mattress anastomosis, the Kiguchi method, which is a novel PJ technique that can improve MIPD. Herein, we describe the Kiguchi method for PJ in MIPD and compare the outcomes between this technique and conventional PJ in OPD.
The current retrospective study included 83 patients in whom the complete obstruction of the main pancreatic duct by pancreatic tumors was absent on preoperative imaging. This research was performed from September 2016 to August 2020 at Fujita Health University Hospital. All patients were evaluated as having a soft pancreatic texture, which is the most important factor associated with POPF development. Briefly, 50 patients underwent OPD with conventional PJ (OPD group). Meanwhile, 33 patients, including 15 and 18 who had LPD and RPD, respectively, underwent MIPD using the Kiguchi method (MIPD group). After a 1:1 propensity score matching, 30 patients in the OPD group were matched to 30 patients in the MIPD group.
The patients' preoperative data did not differ. The grade B/C POPF rate was significantly lower in the MIPD group than in the OPD group (6.7% vs 40.0%, p = 0.002). The MIPD group had a significantly shorter median length of hospital stay than the OPD group (24 vs 30 days, p = 0.004).
The novel Kiguchi method in MIPD significantly reduced the POPF rate in patients without complete obstruction of the main pancreatic duct.
微创胰十二指肠切除术（MIPD），包括腹腔镜胰十二指肠切除术（LPD）和机器人胰十二指肠切除术（RPD），由于胰肠吻合术（PJ）操作技术要求高。术后胰瘘（POPF）是MIPD和开放胰十二指肠切除术（OPD）最严重的并发症。与预期相反，MIPD中的传统PJ并未降低POPF发生率和住院时间。高POPF发生率归因于MIPD过程中遇到的技术问题，包括活动受限和水密性不足。因此，我们开发了包裹式双褥式吻合术，即木口法，这是一种可改善MIPD的新型PJ技术。在此，我们描述MIPD中PJ的木口法，并比较该技术与OPD中传统PJ的结果。
本回顾性研究纳入了83例术前影像学检查未发现胰腺肿瘤导致主胰管完全梗阻的患者。本研究于2016年9月至2020年8月在藤田保健大学医院进行。所有患者均被评估为胰腺质地柔软，这是与POPF发生相关的最重要因素。简而言之，50例患者接受了采用传统PJ的OPD（OPD组）。同时，33例患者，包括15例接受LPD和18例接受RPD的患者，采用木口法接受了MIPD（MIPD组）。经过1:1倾向评分匹配后，OPD组的30例患者与MIPD组的30例患者进行了匹配。
患者的术前数据无差异。MIPD组B/C级POPF发生率显著低于OPD组（6.7%对40.0%，p = 0.0****）。MIPD组的中位住院时间显著短于OPD组（24天对30天，p = 0.0****）。
MIPD中新型木口法显著降低了主胰管未完全梗阻患者的POPF发生率。
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