Propensity score matched comparison of pancreatoduodenectomy with pancreatogastrostomy versus pancreatojejunostomy: A single institution experience shifting from pancreatogastrostomy to pancreatojejunostomy
10.14701/ahbps.25-236
- Author:
Teik Wen LIM
;
Sabrina Hui Xian CHEOK
;
Yvette CHONG
;
Darren Weiquan CHUA
;
Ek Khoon TAN
;
Jin Yao TEO
;
Ye-Xin KOH
;
Peng Chung CHEOW
;
Pierce Kah Hoe CHOW
;
London Lucien Peng Jin OOI
;
Alexander Yaw Fui CHUNG
;
Brian Kim Poh GOH
- Publication Type:Original Article
- From:
Annals of Hepato-Biliary-Pancreatic Surgery
2026;30(1):91-98
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:s/Aims: Postoperative pancreatic fistulas (POPF) remain a major cause of morbidity and mortality following pancreatoduodenectomy (PD). Pancreatogastrostomy (PG) and pancreatojejunostomy (PJ) are the two most commonly used reconstruction techniques, yet evidence favoring one over the other is inconclusive. This study evaluates postoperative outcomes following open PD at a single institution that transitioned from PG to PJ as the preferred reconstruction method.
Methods:This retrospective comparative study included patients who underwent PD between April 2005 and August 2022. Of 757 patients identified, 522 met the inclusion criteria. Propensity score matching (PSM) was performed to adjust for clinically relevant covariates. Primary endpoints were clinically relevant (CR) POPF (grade B/C) and Clavien–Dindo (CD) grade ≥ 3 POPFs. Secondary outcomes included post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), systemic complications, length of hospital stay, and mortality.
Results:Overall, CR-POPF and CD grade ≥ 3 POPFs occurred in 21.3% and 8.0% of patients, respectively. Thirty-day and in-hospital mortality rates were 3.1% and 4.2%. After PSM, 368 patients (184 PG and 184 PJ) were analyzed. Grade B POPFs were more frequent following PJ than PG (24.5% vs. 15.8%, p < 0.001). Although CR-POPF and CD grade ≥ 3 POPFs were numerically higher in the PJ group, differences were not statistically significant. In contrast, DGE, PPH, and in-hospital mortality were significantly higher following PG (37.0% vs. 25.0%, p = 0.025; 16.3% vs. 8.7%, p = 0.025; and 7.6% vs. 2.7%, p = 0.049, respectively).
Conclusions:PG was associated with a lower incidence of grade B POPFs but higher rates of DGE, PPH, and in-hospital mortality.
