Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreatoduodenectomy
O. Ishikawa, H. Ohigashi, S. Imaoka, T. Teshima, T. Inoue, Y. Sasaki, T. Iwanaga and A. Nakaizumi
Department of Surgery, Center for Adult Diseases, Osaka, Japan.
Preoperative irradiation improves both the resectability and curability of
carcinoma of the pancreas head area and should improve patient survival. We
retrospectively investigated the value of preoperative irradiation in
preventing pancreatic fistula formation. Of 76 consecutive patients who
underwent pancreaticojejunostomy by mucosa-to-mucosa anastomosis with a
stent catheter after pancreatoduodenectomy, 22 had received preoperative
irradiation. The irradiation field included the anastomotic site. In two
patients, accidental dislocation of the stent catheter was the apparent
cause of fistula formation, but the other 21 patients in the irradiated
group developed no fistula. In contrast, nine (17%) of 53 patients in the
nonirradiated group developed fistulas. In the irradiated group,
preoperative selenomethionine Se 75 scintigraphy revealed a cold area
corresponding to the pancreas body, which was included in the irradiation
field. Thus, a putative decrease in exocrine function at the pancreatic
anastomotic site could explain why fistula formation was prevented by
preoperative irradiation.
