Efficacy of octreotide in the prevention of complications after pancreaticoduodenectomy in patients with soft pancreas and non-dilated pancreatic duct: A prospective randomized trial

Background: The efficacy of octreotide to prevent postoperative pancreatic fistula(POPF) of pancreaticoduodenectomy(PD) is still controversial. This study aimed to evaluate the effect of postoperative use of octreotide on the outcomes after PD.Methods: This is a prospective randomized controlled trial for postoperative use of octreotide in patients undergoing PD. Patients with soft pancreas and pancreatic duct < 3 mm were randomized to 2 groups.Group I did not receive postoperative octreotide. Group II received postoperative octreotide. The primary end of the study is to compare the rate of POPF.Results: A total of 104 patients were included in the study and were divided into two randomized groups.There were no significant difference in overall complications and its severity. POPF occurred in 11 patients(21.2%) in group I and 10(19.2%) in group II, without statistical significance(P = 0.807). Also, there was no significant differences between both groups regarding the incidence of biliary leakage(P = 0.083), delayed gastric emptying(P = 0.472), and early postoperative mortality(P = 0.727).Conclusions: Octreotide did not reduce postoperative morbidities, reoperation and mortality rate. Also, it did not affect the incidence of POPF and its clinically relevant variants.

Total closure of pancreatic section for end-to-side pancreaticojejunostomy decreases incidence of pancreatic fistula in pancreaticoduodenectomy

BACKGROUND： Postoperative pancreatic fistula （POPF） is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total closure of pancreatic section for end-to-side pancreaticojejunostomy in pancreaticoduodenectomy （PD）. METHODS： This was a prospective randomized clinical trial comparing the outcomes of PD between patients who un- derwent total closure of pancreatic section for end-to-side pancreaticojejunostomy （Group A） vs those who underwent conventional pancreaticojejunostomy （Group B）. The primary endpoint was the incidence of pancreatic fistula. Secondary endpoints were morbidity and mortality rates. RESULTS： One hundred twenty-three patients were included in this study. The POPF rate was significantly lower in Group A than that in Group B （4.8% vs 16.7%, P〈0.05）. About 38.3% patients in Group B developed one or more complications; this rate was 14.3% in Group A （P〈0.01）. The wound/abdomi- nal infection rate was also much higher in Group B than that in Group A （20.0% vs 6.3%, P〈0.05）. Furthermore, the average hospital stays of the two groups were 18 days in Group A, and 24 days in Group B, respectively （P〈0.001）. However, there was no difference in the probability of mortality, biliary leakage,delayed gastric emptying, and pulmonary infection between the two groups. CONCLUSION： Total closure of pancreatic section for end-to- side pancreaticojejunostomy is a safe and effective method for pancreaticojejunostomy in PD.

Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases

BACKGROUND: Pancreatic reconstruction following pancreaticoduodenectomy(PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula(POPF) and its severity if developed with preservation of both exocrine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of reconstruction.This study was to show the best type of pancreatic reconstruction according to the characters of pancreatic stump. METHODS: We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group(absent risk factor), moderate-risk group(presence of one risk factor) and high-risk group(presence of two or more risk factors). RESULTS: A total of 892 patients underwent PD for resection of periampullary tumor. BMI >25 kg/m~2, cirrhotic liver, soft pancreas, pancreatic duct diameter <3 mm, and pancreatic duct location from posterior edge <3 mm are risk variables for development of postoperative complications. POPF developed in 128(14.3%) patients. Delayed gastric emptying occurred in 164(18.4%) patients, biliary leakage developed in 65(7.3%) and pancreatitis presented in 20(2.2%). POPF in low-, moderate-and high-risk groups were 26(8.3%), 65(15.7%) and 37(22.7%) patients, respectively. Postoperative morbidity and mortality were significantly lower with pancreaticogastrostomy(PG) in high-risk group, while pancreaticojejunostomy(PJ) decreases incidence of postoperative steatorrhea in all groups. CONCLUSIONS: Selection of proper pancreatic reconstruction according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in low-and moderate-risk groups.

Pancreaticoduodenectomy with Roux-Y anastomosis in reconstructing the digestive tract: report of 26 patients

Objective: To explore the way to lower the morbidity and mortality of patients after pancreaticoduodenec- tomy. Methods: Between March 1998 and March 2001, 26 patients with periampullary tumors received pancre- aticoduodenectomy (PD) with Roux-Y anastomosis to reconstruct the digestive tract. Of these patients, 6 had ductal cell carcinoma at the head of the pan- creas, 8 distal common bile duct carcinoma, 5 amp- ullar adenocarcinoma of the Vater, 6 duodenal ade- nocarcinoma, and 1 duodenal malignant lynphoma. A 30-40 cm free vascularized segment of the proxi- mal jejunum was taken and pulled up to the bed of the duodenum for end-to-end pancreaticojejunosto- my, end-to-side choledocojejunostomy or side-to-side jejunojejunostomy by a single loop. Results: The operative mortality was zero. Postoper- ative intraabdominal hemorrhage occurred in 2 pa- tients, but no leakage during pancreaticojejunostomy or choledocojejunostomy as well as abdominal infec- tion. The patients were discharged from the hospital on the tenth to fourteenth day after operation. Fol- low-up for 5 to 36 months (mean 21 months) re- vealed chronic steatorrhea and malnutrition in one patient (3.85%), and good digestive function and normal nutritional status in 25 (96.15%). No bile reflux gastritis, retrograde infection, anastomotic ul- cer, and dumping syndrome were observed. Conclusion: Our results show that this procedure can effectively reduce the morbidity and mortality of pa- tients after PD.