Does Pyloric-ring Resection in Pancreaticoduodenectomy Prevent Delayed Gastric Emptying?
DOI:
https://doi.org/10.31584/jhsmr.2021786Keywords:
delayed gastric emptying, pancreaticoduodenectomy, pyloric-ring resectionAbstract
Objective: Delayed gastric emptying (DGE) is a common, post pancreaticoduodenectomy (PD) complication, which prolongs hospital stay, increases the cost of treatment and delays adjuvant therapy. Although, pylorospasm is one of the proposed mechanisms, the results of pyloric ring resection PD remain controversial. Hence, this study investigated whether pyloric ring resection PD decreased the incidence of DGE.
Material and Methods: Between June, 2015 and July, 2018; 74 patients underwent a PD for periampullary lesions, of whom 25 patients received pylorus-preserving PD (PPPD) and 49 patients received pyloric-ring resection PD (PRPD). DGE was classified according to the International Study Group of Pancreatic Surgery.
Results: The incidence of DGE in the PPPD group and PRPD group were 48.0% (12 of 25 patients) and 20.4% (10 of 49 patients), respectively (p-value=0.029). Factors associated with DGE were pyloric preserving [adjusted Odds ratio (OR)=8.26, 95% confidence interval (CI): 1.96-34.82, p-value=0.002], preoperative biliary drainage (adjusted OR=0.19, 95% Cl: 0.05-0.78, p-value=0.013) and postoperative intraabdominal collection (adjusted OR=37, 95% Cl: 5.68-241.24, p-value<0.001).
Conclusion: PRPD demonstrated a significant decrease of DGE, and should be one of the standard surgical treatments for periampullary carcinoma.
References
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Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R, et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB 2010;12:610–8.
Eisenberg JD, Rosato EL, Lavu H, Yeo CJ, Winter JM. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg 2015;19:1572– 80.
Panwar R, Pal S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int 2017;16:353–63.
Kim DK, Hindenburg AA, Sharma SK, Suk CH, Gress FG, Staszewski H, et al. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? Ann Surg Oncol 2005;12:222–7.
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Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.
Tol JAMG, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2014;156:591–600.
Hayashibe A, Kameyama M, Shinbo M, Makimoto S. The surgical procedure and clinical results of subtotal stomach preserving pancreaticoduodenectomy (SSPPD) in comparison with pylorus preserving pancreaticoduodenectomy (PPPD). J Surg Oncol 2007;95:106–9.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH)–An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007;142:20–5.
Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, et al. Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 2017;161: 365–72.
Hackert T, Probst P, Knebel P, Doerr-Harim C, Bruckner T, Klaiber U, et al. Pylorus resection does not reduce delayed gastric emptying after partial pancreatoduodenectomy: a blinded randomized controlled trial (PROPP Study, DRKS00004191). Ann Surg 2018;267:1021–7.
Kang CM, Lee JH. Pathophysiology after pancreaticoduodenectomy. World J Gastroenterol 2015;21:5794–804.
Qu H, Sun GR, Zhou SQ, He QS. Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis. EJSO 2013;39:213–23.
Nieuwenhuijs VB, van Dijk JE, Gooszen HG, Akkermans LMA. Obstructive jaundice, bacterial translocation and interdigestive small-bowel motility in rats. Digestion 2000;62:255–61.
Camilleri M, Chedid V, Ford AC, Haruma K, Horowitz M, Jones KL, et al. Gastroparesis. Nat Rev Dis Primer 2018;4:41-59.
Traverso LW, Longmire WP. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 1978;146: 959–62.
Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL. Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg 2000;231:293–300.
Fujii T, Kanda M, Kodera Y, Nagai S, Sahin TT, Hayashi M, et al. Preservation of the pyloric ring has little value in surgery for pancreatic head cancer: a comparative study comparing three surgical procedures. Ann Surg Oncol 2012; 19:176–83.
Parmar AD, Sheffield KM, Vargas GM, Pitt HA, Kilbane EM, Hall BL, et al. Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB 2013;15:763– 72.
Tanaka M. Gastroparesis after a pylorus-preserving pancreatoduodenectomy. Surg Today 2005;35:345–50.
Ahmad SA, Edwards MJ, Sutton JM, Grewal SS, Hanseman DJ, Maithel SK, et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg 2012;256:529–37.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142: 761–8.
Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R, et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB 2010;12:610–8.
Eisenberg JD, Rosato EL, Lavu H, Yeo CJ, Winter JM. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg 2015;19:1572– 80.
Panwar R, Pal S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int 2017;16:353–63.
Kim DK, Hindenburg AA, Sharma SK, Suk CH, Gress FG, Staszewski H, et al. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? Ann Surg Oncol 2005;12:222–7.
Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, et al. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg 2011;253:495–501.
Matsumoto I, Shinzeki M, Asari S, Goto T, Shirakawa S, Ajiki T, et al. A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status: SSPPD vs. PPPD. J Surg Oncol 2014;109:690–6.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.
Tol JAMG, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2014;156:591–600.
Hayashibe A, Kameyama M, Shinbo M, Makimoto S. The surgical procedure and clinical results of subtotal stomach preserving pancreaticoduodenectomy (SSPPD) in comparison with pylorus preserving pancreaticoduodenectomy (PPPD). J Surg Oncol 2007;95:106–9.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH)–An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007;142:20–5.
Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, et al. Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 2017;161: 365–72.
Hackert T, Probst P, Knebel P, Doerr-Harim C, Bruckner T, Klaiber U, et al. Pylorus resection does not reduce delayed gastric emptying after partial pancreatoduodenectomy: a blinded randomized controlled trial (PROPP Study, DRKS00004191). Ann Surg 2018;267:1021–7.
Kang CM, Lee JH. Pathophysiology after pancreaticoduodenectomy. World J Gastroenterol 2015;21:5794–804.
Qu H, Sun GR, Zhou SQ, He QS. Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis. EJSO 2013;39:213–23.
Nieuwenhuijs VB, van Dijk JE, Gooszen HG, Akkermans LMA. Obstructive jaundice, bacterial translocation and interdigestive small-bowel motility in rats. Digestion 2000;62:255–61.
Camilleri M, Chedid V, Ford AC, Haruma K, Horowitz M, Jones KL, et al. Gastroparesis. Nat Rev Dis Primer 2018;4:41-59.
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Published
2021-06-01
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Thongkan T, Pitakteerabundit T, Wiboonkhwan N- ak. Does Pyloric-ring Resection in Pancreaticoduodenectomy Prevent Delayed Gastric Emptying?. J Health Sci Med Res [Internet]. 2021 Jun. 1 [cited 2024 Dec. 23];39(4):303-12. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/250159
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