Pancreaticojejunostomy with duct-to-mucosa versus invagination techniques: a propensity-score matching analysis based
Apostolos Gaitanidis1, Winifred M Lo2, Rachel A Burke2
1Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Division of Surgical Oncology, Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
Background:
The superiority of duct-to-mucosa (DTM) and invagination (IVG) techniques for pancreaticoduodenectomy has not been established. This is the largest study to compare their outcomes with granular data regarding parenchymal texture and duct size.
Methods:
The NSQIP database for patients undergoing open pancreaticoduodenectomy was investigated. Subgroups were based on pancreatic duct size (<3 mm, 3-6 mm, >6 mm) and gland texture (soft, intermediate, hard). Propensity score matching (PSM) was used. The primary outcome was postoperative pancreatic fistula (POPF).
Results:
After PSM, there were no differences in the rates of POPF in any subgroup by duct size or gland texture. When examining secondary outcomes, the IVG group was associated with shorter duration of postoperative drain presence among patients with 3-6 mm ducts.
Conclusions:
No differences exist in POPF rates between DTM and IVG techniques in subgroups of patients with similar pancreatic duct size and parenchymal texture. The IVG technique may be associated with earlier drain removal in some patients.
