Surgical Procedures

The surgical procedure was subtotal stomach preserving PD with the modified Child method in all patients. Pancreaticojejunostomy consisted of approximation of the pancreas stump and jejunal wall, followed by duct to mucosa anastomosis. All pancreaticojejunal anastomoses were stented using 4- to 7.5-Fr polyvinyl chloride tubes (Sumitomo Bakelite, Tokyo, Japan) according to diameter of the main pancreatic duct (MPD), which were guided externally through the jejunal loops. The indication for dissection of the right-sided nerve plexus around the superior mesenteric artery (SMA) was determined based on the findings of preoperative diagnostic imaging. All postoperative complications occurring within 30 days after surgery or during the hospital stay were classified according to the criteria proposed by Dindo and Clavien.¹⁵ Pancreatic fistula was defined according to the definition of the International Study Group of Pancreatic Fistula.¹⁶ Adjuvant chemotherapy was performed in 98 (40.0%) patients based on the postoperative histological diagnosis. Pancreatic enzyme supplementation was performed based on the judgment of the surgeon.