Open Total Pancreatectomy With Modified Cattell-Imanaga Reconstruction: How Do We Do It?

Area of Science:

• Surgical Oncology
• Gastroenterology
• Pancreatic Surgery

Background:

• The Cattell-Imanaga reconstruction (CIR) is a preferred method after pancreaticoduodenectomy due to its physiological benefits.
• Previous reports have not detailed CIR application following total pancreatectomy (TP).

Purpose of the Study:

• To describe the modified CIR (mCIR) surgical technique for open total pancreatectomy (TP).
• To report the initial institutional experience and postoperative outcomes of mCIR in TP patients.

Main Methods:

• The study involved 89 patients undergoing open TP with the mCIR technique at a high-volume center.
• mCIR involves proximal gastro-/duodeno-jejunostomy (G/DJ) and distal hepatico-jejunostomy (HJ) on a single transmesocolic limb.
• Both en bloc and stepwise TP were utilized, with stepwise TP employed for specific indications like positive margins or high pancreatic fistula risk.

Main Results:

• Postoperative complications included Grade B-C biliary fistula (6.7%), cholangitis (2.2%), delayed gastric emptying (11%), and duodeno-jejunostomy leakage (1.1%).
• Endoscopic intervention was the primary management for hepatico-jejunostomy complications.
• Major morbidity was 23.6%, 90-day mortality was 3.4%, and the readmission rate was 9.7%.

Conclusions:

• The modified Cattell-Imanaga reconstruction (mCIR) is a feasible and safe technique for patients undergoing total pancreatectomy (TP).
• Postoperative outcomes associated with mCIR following TP are comparable to those reported for traditional reconstruction methods.
• This study provides the first description and outcome data for mCIR after TP.