Landmark Series in Pancreatic Tumors: Anastomotic Techniques and Route of Reconstruction

• Published in: Annals of surgical oncology Vol. 28; no. 4; pp. 2227 - 2234
• Main Authors: Sachs, Teviah E., Tseng, Jennifer F.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-04-2021; Springer Nature B.V
• Subjects: Anastomosis; Anastomosis, Surgical; Anastomotic Leak - etiology; Fistula; Humans; Implants; Medicine; Medicine & Public Health; Morbidity; Mortality; Oncology; Pancreas; Pancreas - surgery; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - surgery; Pancreatic Tumors; Pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Patients; Postoperative Complications; Small intestine; Surgery; Surgical Oncology; Surgical outcomes; Sutures; Tumors
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-09663-y

Introduction
Pancreaticoduodenectomy is one of the more complicated operations that exists in surgery, and is fraught with potential morbidity, the most well-known, and dreaded, of which is the pancreatic leak. While much of the risk associated with pancreatic leak is inherent to the operation, there have been no shortage of techniques employed by surgeons to try to mitigate that risk.
Methods
We focused on four topics of greatest conjecture with regard to reconstruction after pancreaticoduodenectomy: (1) the type of anastomosis, (2) the enteral organ to which the pancreas is sewn, (3) whether to preserve the pylorus and (4) whether or not to use anastomotic silastic stents. We identified the most relevant randomized control trials on each topic, which were appropriately powered.
Results
We identified a total of 15 studies for evaluation, (type of anastomosis:
n
= 4; enteral organ to which the pancreas is sewn:
n
= 4; whether to preserve the pylorus, n=3; and whether or not to use anastomotic silastic stents,
n
= 4). In each group of comparisons, there was no definitive conclusion to be made on superiority of reconstruction.
Conclusion
While clear consensus on how best to reconstruct the anatomy after pancreaticoduodenectomy has not yet been reached, we present the following review in the hope of providing some understanding of the literature for the pancreatic surgeon.