Surgical Strategy and Outcome in Patients Undergoing Pancreaticoduodenectomy After Gastric Resection: A Three-Center Experience with 39 Patients

Abstract

Background: Stomach cancer is the second most commonly diagnosed cancer in Korea. Although the long-term survival outcome has improved, secondary primary tumors from periampullary regions are increasing inevitably and pancreaticoduodenectomy (PD) following gastrectomy is challenging. This study evaluates the surgical outcomes of PD following gastrectomy and suggests the optimum method for reconstruction.

Methods: Patients who underwent curative PD with a history of gastric resection between 2005 and 2015 were assessed retrospectively. PD was performed according to the standard fashion, with the aim of creating a new pancreaticobiliary limb with sufficient length (40-50 cm). Different reconstructive methods were employed during PD according to the previous gastrectomy type.

Results: A total of 3064 patients underwent PD, 39 of whom had previous gastrectomies including 12 with Billroth I gastrectomy, 20 with Billroth II gastrectomy, and seven patients with total gastrectomy (TG). In patients with Billroth I gastrectomy, all of the previous gastroduodenostomy site was resected for specimen retrieval. All previous esophagojejunostomy site was preserved in seven patients who had TG. In the Billroth II patients, the gastrojejunostomy site was preserved in 17 patients. Re-operation after PD was required in two patients, and 14 patients (36 %) developed pancreatic fistula and five (13 %) of grade B or higher.

Conclusions: Our study has been the largest report so far of PD following gastric resection, and we were able to confirm the safety and the feasibility of PD procedure. We therefore suggest standardizing the reconstruction method for PD following gastrectomy based on the type of previous gastrectomy.