{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:08:32Z","timestamp":1773378512691,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T00:00:00Z","timestamp":1712102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Pancreatic reconstruction after pancreaticoduodenectomy (PD) that leaves a small remnant pancreas is often difficult. Pancreatic fistula is a major complication after PD, and fistulas are rare in patients with hard pancreas. However, the clinical impact of non\u2010reconstructed small remnant after PD with hard pancreas is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included all patients who underwent PD for pancreatic tumor without pancreatic reconstruction in two institutions supervised by one surgeon between January 2004 and March 2021. Their short\u2010 or long\u2010term outcome after surgery was retrospectively analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PD was performed in 774 patients, of whom 16 patients were without reconstruction (2.1%) with negative margins at the pancreatic stump. Pancreatic transection was performed above or to the left of the superior mesenteric artery, with a median remnant pancreas length of 3.7\u2009cm (range, 1.3\u201310.0). A major complication (\u2265 Clavien\u2013Dindo Grade IIIa) occurred in one patient (6%). Fistula of grade B occurred in one patient (6%). After a median follow\u2010up of 44\u2009months (95%CI, 10.6\u201377.3), insulin administration was unnecessary in 11 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The preservation of a small pancreatic remnant without reconstruction after PD can be performed safely and may enable the keeping of pancreatic endocrine function for some selected patients with hard pancreas.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ags3.12795","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T07:04:30Z","timestamp":1712127870000},"page":"860-867","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Low incidence of pancreatic fistula and well\u2010preserved endocrine function with non\u2010reconstructed small remnant pancreas after pancreaticoduodenectomy"],"prefix":"10.1002","volume":"8","author":[{"given":"Mamiko","family":"Miyashita","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary\u2010Pancreatic Surgery Juntendo University Graduate School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuji","family":"Yoshioka","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary\u2010Pancreatic Surgery Juntendo University Graduate School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Fukumura","sequence":"additional","affiliation":[{"name":"Department of Human Pathology Juntendo University Graduate School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Takamatsu","sequence":"additional","affiliation":[{"name":"Division of Pathology The Cancer Institute Japanese Foundation for Cancer Research  Tokyo 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