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

Sep 28, 2026

Hepatopancreatoduodenectomy is an effective but highly invasive procedure for margin-negative curative resection in biliary tract cancer, with persistent concerns about high postoperative complication rates, particularly pancreatic fistula and hospital mortality. This single-center retrospective review compared pancreaticojejunostomy and immediate pancreaticogastrostomy after HPD across 33 consecutive patients, evaluating short-term outcomes and longer-term physiologic status.

LanguageEnglish

CategoryHealthcare

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Abstract

Background and Purpose

Patients and Methods

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Introduction

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Preoperative Management

Annals of Gastroenterological Surgery ORIGINAL ARTICLE OPEN ACCESS Immediate Reconstruction of Pancretaticogastrostomy Following Hepatopancreatoduodenectomy for Biliary Tact Cancer: A Single-Center Review of33 Consecutive Patients Ryusei Matsuyama | Yasuhiro Yabusita | Tomoaki Takahashi | Yutaro Kikuchi | Kouta Sahara | Kentaro Miyake | Yu Sawada | Yuuki Homma | Takafumi Kumamoto | Itaru Endo Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan Correspondence: Ryusei Matsuyama ([ryusei@yokohama-cu.ac.jp](ryusei@yokohama-cu.ac.jp)) Received: 27 April 2025 | Revised: 30 June 2025 | Accepted: 10 July 2025 Funding: The authors received no specific funding for this work. Keywords: biliary tract cancer | hepatopancreatoduodenectomy | mortality | pancreatic fistula | pancreaticogastrostomy ABSTRACT 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 recurrencefree 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. 1 | Introduction Hepatopancreatoduodenectomy (HPD) is a definitive surgery to achieve margin-negative resection for patients with locally spreading biliary tract cancer (BTC) such as gallbladder cancer with biliary infiltration or perihilar cholangiocarcinoma extending to the intrapancreatic bile duct [1, 2]. However, the morbidity and mortality of HPD are not negligible, and especially the rate of postoperative pancreatic fistula (POPF) of HPD is reportedly high [3, 4], and it is one of the most serious complications that can directly lead to hospital death. Several studies have reported that a pancreaticogastrostomy (PG) is superior to a pancreaticojejunostomy (PJ) for the prevention of POPF after pancreaticoduodenectomy (PD) [5, 6] . Various pancreatogastric anastomosis methods are introduced This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2025 The Author(s). Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery. Annals of Gastroenterological Surgery, 2026; 10:187–196 187 [https://doi.org/10.1002/ags3.70069](https://

FAQs

Why is pancreaticogastrostomy considered after hepatopancreatoduodenectomy in biliary tract cancer patients?

The study addresses persistent problems after HPD, especially postoperative pancreatic fistula and hospital mortality, by assessing whether pancreaticogastrostomy improves outcomes compared with pancreaticojejunostomy.

How were patients grouped in this review?

Patients who underwent HPD were divided into two cohorts: 11 cases reconstructed with PJ before 2011 and 33 cases reconstructed with PG after 2012.

What were the main comparative outcomes regarding postoperative pancreatic fistula and hospital mortality?

Grade B/C postoperative pancreatic fistula incidence was lower in the PG group than in the PJ group, and hospital mortality was also lower in the PG group, with differences reported as statistically significant for POPF.

Sep 28, 2026

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