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Research Article

Academia Journal of Scientific Research 5(11): 552-562, November 2017
DOI: 10.15413/ajsr.2017.0719
ISSN: 2315-7712
2017 Academia Publishing 



Dunking Pancreatojejunostomy versus Duct-to-mucosa Pancreatojejunostomy after Pancreatoduodenectomy for Distal Bile Duct Carcinoma

Accepted 9th October 2017

Yukihiro Iso*, Takayuki Shiraki, Takatsugu Matsumoto, Yuki Sakuraoka, Kyung Hwa Park, Keigo Tani, Hiroyuki Hachiya, Takayuki Shimizu, Norisuke Shibuya, Kazuma Tago, Genki Tanaka, Takashi Suzuki, Shozo Mori, Masato Kato, Mitsuru Ishizuka, Taku Aoki and Keiichi Kubota

Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Mibu, Tochigi 321-0293, Japan.


Pancreatoduodenectomy (PD) is widely performed for distal bile duct carcinoma (DBC). Pancreatic fistula (PF), one of the major complications after PD, is the leading cause of morbidity and mortality. To reduce the incidence of PF, many methods have been developed. Dunking pancreatojejunostomy (DUNK) and duct-to-mucosa pancreatojejunostomy (DUCT) are two representative pancreatojejunostomy (PJ) techniques. The aim of this study was to assess the relative effectiveness of the DUNK and DUCT techniques for PJ after PD for DBC. Eighty-six (86) DBC patients who had undergone PD at a single institution between April, 2000 and January, 2014 were enrolled. The patients were divided into two groups: a DUNK and DUCT group. Perioperative data and outcome were compared between the two groups. Among the patients, 54 underwent DUNK PJ (62.8% of the total), while 32 underwent DUCT PJ (37.2%). The 1-, 3- and 5-year survival rates in the DUNK group were 94.3, 54.3 and 37.1%, respectively, while those in the DUCT group were 100.0, 85.7 and 57.1%, respectively (P= 0.01). Univariate analysis revealed that pancreatic duct diameter (<1.5/>1.5 mm; odds ratio 4.370; 95% CI, 1.379-13.84; P= 0.012) and surgical procedure (DUNK/DUCT; odds ratio, 0.096; 95% CI, 0.026 - 0.354; P= 0.001) were associated with post-operative PF. Multivariate analysis revealed that only surgical procedure (odds ratio, 5.143; 95% CI, 1.126-23.48; P= 0.034) was associated with post-operative PF. Fifty-five (55) patients did not develop PF and had ISGPF grade A (PF0, 1 group; 63.9%) and 31 patients had ISGPF grade B or C (PF2, 3 group; 36.1%). The 1-, 3- and 5-year survival rates in the PF0,1 group were 100.0%, 66.9% and 54.4%, respectively, while those in the PF2, 3 group were 84.0, 37.3 and 32.7%, respectively (P= 0.02). DUCT reduces the incidence of PF, thus, contributing to better post-operative survival.

Keywords: Dunking pancreatojejunostomy, duct-to-mucosa pancreatojejunostomy, pancreatoduodenectomy, distal bile duct carcinoma, soft pancreas, pancreatic fistula, reduced complication rate.


This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article as:
Iso Y, Shiraki T, Matsumoto T, Sakuraoka Y, Park KH, Tani K, Hachiya H, Shimizu T, Shibuya N, Tago K, Tanaka G, Suzuki T, Mori S, Kato M, Ishizuka M, Aoki T, Kubota K (2017). Dunking Pancreatojejunostomy versus Duct-to-mucosa Pancreatojejunostomy after Pancreatoduodenectomy for Distal Bile Duct Carcinoma. Acad. J. Sci. Res. 5(11): 552-562.

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