Multivariate Analysis of Technical Variables in Pancreaticoduodenectomy: The Effect of Pylorus Preservation and Retromesenteric Jejunal Position on Early Outcome
Canadian Journal of Surgery
Background: To evaluate the effect of technical modifications to pancreaticoduodenectomy (PD) on postoperative outcome, we established a register of all patients undergoing PD at Victoria General Hospital (Queen Elizabeth II Health Sciences Centre), a tertiary care, university-affiliated hospital.
Patients and method: Data from 78 consecutive patients who underwent PD from January 1998 through November 2000 were collected for univariate and multivariate analyses of clinical and technical factors on early outcome after PD, including duration of gastric stasis, development of complications and length of hospital stay.
Results: Two patients (2.6%) died; complications were recorded in 43 (55%). Upon univariate analysis, 3 factors (a diagnosis of chronic pancreatitis, pylorus preservation, and route of the jejunal limb) significantly affected duration of gastric stasis; but on multivariate analysis, only pylorus preservation and jejunal-limb route remained significant. Retromesenteric jejunal-limb placement was associated with longer periods of gastric stasis (mean 11.9 d, standard deviation [SD] 8.1 d) than the antemesenteric (retrocolic) route (mean 7.2, SD 3.6 d; p < 0.05); likewise pyloric preservation (mean gastric stasis 10.4 d, SD 5.9 d) compared with resection of the pylorus (mean 7.0 d, SD 3.2 d; p < 0.05). Pancreatic leaks occurred in 18% of retromesenteric and 8% of antemesenteric reconstructions (p = 0.3). Fewer patients with mucomucosal pancreaticojejunostomy suffered complications than those with invaginated anastomoses, but their hospital stays were similar in length.
Conclusion: Route of the jejunal efferent limb and preservation of the pylorus are independent technical variables affecting early outcome after PD.