Functional, biological, and radiological evaluation of the pancreaticojejunal anastomosis 1 year after pancreatoduodenectomy: a prospective study

Gaëtan Romain Joliat, Pierre Allemann, Ismail Labgaa, Nicolas Demartines, Naik Vietti Violi, Sabine Schmidt, Markus Schäfer

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: This prospective study aimed to analyze the functional, biological, and radiological aspects of the pancreatic anastomosis 1 year after pancreatoduodenectomy (PD). Methods: From 2016 to 2019, patients with PD indication were screened. Questionnaires about pancreas insufficiency, fecal elastase tests, and magnetic resonance imaging (MRI) were performed before and 1 year after PD. Results: Twenty patients were prospectively included. The only difference between pre- and postoperative questionnaires was constipation (less frequent 1 year after PD). Median pre- and postoperative fecal elastase levels were 96 μg/g (IQR 15–196, normal value > 200) and 15 μg/g (IQR 15–26, p = 0.042). There were no significant differences in terms of main pancreatic duct (MPD) size (4, IQR 3–5 vs. 4 mm, IQR 3–5, p = 0.892), border regularity, stenosis, visibility, image improvement, and secondary pancreatic duct dilation before and after secretin injection. All patients but one (2 refused and 2 were lost to follow-up, 15/16, 94%) had a patent pancreaticojejunal anastomosis on 1-year MRI. Conclusion: Although median 1-year fecal elastase was significantly lower than preoperatively, suggesting that exocrine secretion was altered, the anatomical outcome as assessed by MRI was excellent showing high patency rate (15/16, 94%) at 1 year. This emphasizes the difference between anatomy and function.

Original languageEnglish
Article number326
JournalLangenbeck's Archives of Surgery
Volume408
Issue number1
DOIs
StatePublished - Dec 2023
Externally publishedYes

Keywords

  • Cancer
  • Complication
  • Pancreatectomy
  • Permeability

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