ASO Author Reflections: A Novel Technique for Single Layer Pancreatojejunostomy is not Inferior to Modified Blumgart Ana
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: A Novel Technique for Single Layer Pancreatojejunostomy is not Inferior to Modified Blumgart Anastomosis in Robotic Pancreatoduodenectomy—Results of a Randomized, Controlled Trial Qu Liu, MD, and Rong Liu, MD, PhD Faculty of Hepatopancreatobiliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
PAST In order to reduce the rate of postoperative pancreatic fistula (POPF), surgeons have designed a number of pancreaticojejunostomy (PJ) techniques, among which Blumgart anastomosis has attracted great attention and is widely used in minimally invasive surgery.1–3 However, it is difficult to perform Blumgart anastomosis in robotic pancreaticoduodenectomy (RPD) because of the limited operating space and lack of force feedback, which has limited the application of RPD to some extent. Recently, we present a novel, single-layer, continuous suture (SCS) technique, which simplifies the PJ procedure for RPDs and is associated with favorable clinical outcomes.4 The difference between the two PJ methods for RPD in terms of POPF is still unknown. PRESENT We conducted a randomized, controlled trial (RCT) comparing SCS anastomosis with the modified Blumgart anastomosis (MBA) for PJ during RPD.5 In our study, 89 patients randomized to the SCS group and 93 patients randomized to the MBA group. Our study found that the clinical related POPF (CR-POPF) rate in the SCS group was not inferior to that in the MBA group. Secondary outcomes included operation time, blood loss,
Ó Society of Surgical Oncology 2020 First Received: 25 September 2020 Accepted: 25 September 2020 R. Liu, MD, PhD e-mail: [email protected]
postoperative hospital stay, as well as the rates of morbidity and mortality were no significant differences between the two groups. Furthermore, we reported that the SCS group showed a significantly shorter duration to perform PJ than the MBA group, even in the patients with soft pancreas and small main pancreatic duct. FUTURE We will analyze the learning curve of SCS technique for RPD in terms of CR-POPF rate in the future. Further randomized, controlled trial comparing RPD and OPD is required to evaluate the safety and effectiveness of RPD for benign or malignant tumors in the head of the pancreas. DISCLOSURE
The authors report no conflicts of interest.
REFERENCES 1. Hirono S, Kawai M, Okada KI, et al. Modified Blumgart mattress suture versus conventional interrupted suture in pancreaticojejunostomy during pancreaticoduodenectomy: randomized controlled trial. Ann Surg. 2019;269:243–51. 2. Kleespies A, Rentsch M, Seeliger H, Albertsmeier M, Jauch KW, Bruns CJ. Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg. 2009;96:741–50. 3. Wang SE, Shyr BU, Chen SC, Shyr YM. Comparison between robotic and open pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: a propensity score-matched study. Surgery. 2018;164:1162–7. 4. Liu Q, Zhao Z, Gao Y, et al. Novel single-laye
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