Evolution and precision trends of pancreaticojejunostomy in pancreaticoduodenectomy

Pancreatic cancer is a highly malignant tumor associated with a generally poor prognosis. Pancreaticoduodenectomy remains the only potentially curative surgical treatment for pancreatic head and periampullary cancers. As the core step of Pancreaticoduodenectomy, pancreaticojejunostomy is directly associated with postoperative complications, particularly postoperative pancreatic fistula (POPF), which significantly impacts patient outcomes. Despite continuous advancements in surgical techniques, the risk of POPF remains high. Its occurrence is closely related to patient baseline status, extent of tumor invasion, pancreatic texture, main pancreatic duct diameter, and the choice of anastomotic technique. The selection of anastomotic technique should be individualized based on the local anatomical characteristics of the pancreas, overall patient condition, and surgeon experience. However, no universally accepted standard technique has yet been established internationally. To this end, this article systematically reviews the developmental history of pancreaticojejunostomy techniques and explores their evolving trend toward precision, aiming to provide a theoretical basis and practical reference for surgeons to perform precise and safe pancreaticojejunostomy during Pancreaticoduodenectomy.