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

Dooin Lee, Jae Hoon Lee, Dongho Choi, ChangMoo Kang, Jae Uk Chong, Song Chul Kim, Kyeong Geun Lee

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)552-558
Number of pages7
JournalWorld Journal of Surgery
Volume41
Issue number2
DOIs
Publication statusPublished - 2017 Feb 1

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Pancreaticoduodenectomy
Gastrectomy
Stomach
Gastroenterostomy
Pancreatic Fistula
Gastric Bypass
Korea
Stomach Neoplasms
Neoplasms
Extremities

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Lee, Dooin ; Lee, Jae Hoon ; Choi, Dongho ; Kang, ChangMoo ; Chong, Jae Uk ; Kim, Song Chul ; Lee, Kyeong Geun. / Surgical Strategy and Outcome in Patients Undergoing Pancreaticoduodenectomy After Gastric Resection : A Three-Center Experience with 39 Patients. In: World Journal of Surgery. 2017 ; Vol. 41, No. 2. pp. 552-558.
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title = "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.",
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Surgical Strategy and Outcome in Patients Undergoing Pancreaticoduodenectomy After Gastric Resection : A Three-Center Experience with 39 Patients. / Lee, Dooin; Lee, Jae Hoon; Choi, Dongho; Kang, ChangMoo; Chong, Jae Uk; Kim, Song Chul; Lee, Kyeong Geun.

In: World Journal of Surgery, Vol. 41, No. 2, 01.02.2017, p. 552-558.

Research output: Contribution to journalArticle

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T1 - Surgical Strategy and Outcome in Patients Undergoing Pancreaticoduodenectomy After Gastric Resection

T2 - A Three-Center Experience with 39 Patients

AU - Lee, Dooin

AU - Lee, Jae Hoon

AU - Choi, Dongho

AU - Kang, ChangMoo

AU - Chong, Jae Uk

AU - Kim, Song Chul

AU - Lee, Kyeong Geun

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N2 - 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.

AB - 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.

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