Immediate Reconstruction of Pancretaticogastrostomy Following Hepatopancreatoduodenectomy for Biliary Tact Cancer: A Single‐Center Review of 33 Consecutive Patients

Background and Purpose Although hepatopancreaticoduodenectomy (HPD) is effective for margin‐negative curative resection of biliary tract cancer (BTC), it is a highly invasive procedure, and its high complication rate, especially post‐operative pancreatic fistula, and hospital mortality are still problems. In this study, we investigated the clinical usefulness of pancreaticogastrostomy (PG) in BTC patients with HPD. Patients and Methods Of the 878 BTC resected in our institution from April 1992 to December 2022, 44 patients who underwent HPD for perihilar cholangiocarcinoma (PHC) or gallbladder cancer (GBC) were enrolled in this study. Perioperative factors and short‐term postoperative outcomes were evaluated in two groups of 11 patients reconstructed with PJ and 33 patients reconstructed with PG. In addition, the temporal changes in glucose tolerance, nutritional status, and postoperative pancreatic morphology were examined. Results The incidence of Grade B/C postoperative pancreatic fistula (POPF) was 5 patients (45%) in the PJ group and 4 patients (12%) in the PG group, which was significantly lower in the PG group ( p = 0.043). Hospital mortality was observed in 3 patients (27%) in the PJ group and 1 patient (3%) in the PG group ( p = 0.060). In patients who underwent PG and were recurrence‐free 24 months after surgery, there were no significant changes in HbA1c, serum Albumin, prognostic nutritional index (PNI), neutrophil‐lymphocyte ratio (NLR) and pancreatic duct diameter at 12 and 24 months after surgery. Conclusions PG with immediate reconstruction in HPD for BTC patients may reduce the rate of POPF and operative death without affecting long‐term postoperative physiological statuses.