Objectives Central pancreatectomy is an alternative to pancreaticoduodenectomy and distal pancreatectomy in benign tumors of pancreatic isthmus management. It is known for a high postoperative fistula rate. The purpose of this study was to compare postoperative pancreatic fistula incidence between pancreatico-jejunostomy and pancreatico-gastrostomy. Methods Fifty-eight patients (mean age 53.9±1.9 years) who underwent a central pancreatectomy in four French University Hospitals from 1988 to 2011 were analyzed. The distal pancreatic remnant was either anastomosed to the stomach (44.8%, n=25) or to a Roux-en-Y jejunal loop (55.2%, n=35) with routine external drainage allowing a systematic search for postoperative pancreatic fistula. Postoperative pancreatic fistula severity was classified according ISGPF classification and Clavien-Dindo classification. Results The groups were similar on sex ratio, mean age, ASA score, pancreas texture, operative time and operative blood loss. Mean follow up was 36.2±3.9 months. Postoperative pancreatic fistula were significantly more frequent after pancreatico-gastrostomy (76.9% vs. 37.5%, p=0.003). Pancreatico-gastrostomy was associated with significantly higher grade of postoperative pancreatic fistula both when graded with ISGPF classification (p=0.012) and Clavien-Dindo classification (p=0.044). There was no significant difference in postoperative bleeding (0.918) and delayed gastric emptying (0.877) between the two groups. Hospital length stay was increased after pancreatico-gastrostomy (23.6±3.5 days vs. 16.5±1.9 days, p=0.071). There was no significant difference in incidence of long-term exocrine (3.8% vs. 19.2%, p=0.134) and endocrine (7.7% vs. 9.4%, p=0.575) pancreatic insufficiencies. Conclusions Pancreatico-gastrostomy was associated with a significantly higher POPF incidence and severity in central pancreatectomy. We recommend performing pancreatico-jejunostomy especially in older patients to improve central pancreatectomy outcomes.
Frédéric Borel, Mehdi Ouaissi, Aude Merdrignac, Aurelien Venara, Valéria De Franco, Laurent Sulpice, Antoine Hamy, Nicolas Regenet