Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial
Objectives: To assess pancreatic fistula rate and secondary endpoints after pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy in the setting of a multicenter randomized controlled trial. Background: PJ and PG are established methods for reconstruc...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
March 2016
|
| In: |
Annals of surgery
Year: 2016, Volume: 263, Issue: 3, Pages: 440-449 |
| ISSN: | 1528-1140 |
| DOI: | 10.1097/SLA.0000000000001240 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1097/SLA.0000000000001240 Verlag, Volltext: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-201603000-00006 
|
| Author Notes: | Tobias Keck, MD, MBA, FACS; U.F. Wellner, MD; M. Bahra, MD; F. Klein, MD; O. Sick, MSc; M. Niedergethmann, MD; T.J. Wilhelm, MD; S.A. Farkas, MD; T. Börner, MD; C. Bruns, MD; A. Kleespies, MD; J. Kleeff, MD; A.L. Mihaljevic, MD; W. Uhl, MD; A. Chromik, MD; V. Fendrich, MD; K. Heeger, MD; W. Padberg, MD; A. Hecker, MD; U.P. Neumann, MD; K. Junge, MD; J.C. Kalff, MD; T.R. Glowka, MD; J. Werner, MD; P. Knebel, MD; P. Piso, MD; M. Mayr, MD; J. Izbicki, MD; Y. Vashist, MD; P. Bronsert, MD; T. Bruckner, PhD; R. Limprecht, MSc; M.K. Diener, MD; I. Rossion, MD; I. Wegener, MD; and U.T. Hopt, MD |
| Summary: | Objectives: To assess pancreatic fistula rate and secondary endpoints after pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy in the setting of a multicenter randomized controlled trial. Background: PJ and PG are established methods for reconstruction in pancreatoduodenectomy. Recent prospective trials suggest superiority of the PG regarding perioperative complications. Methods: A multicenter prospective randomized controlled trial comparing PG with PJ was conducted involving 14 German high-volume academic centers for pancreatic surgery. The primary endpoint was clinically relevant postoperative pancreatic fistula. Secondary endpoints comprised perioperative outcome and pancreatic function and quality of life measured at 6 and 12 months of follow-up. Results: From May 2011 to December 2012, 440 patients were randomized, and 320 were included in the intention-to-treat analysis. There was no significant difference in the rate of grade B/C fistula after PG versus PJ (20% vs 22%, P = 0.617). The overall incidence of grade B/C fistula was 21%, and the in-hospital mortality was 6%. Multivariate analysis of the primary endpoint disclosed soft pancreatic texture (odds ratio: 2.1, P = 0.016) as the only independent risk factor. Compared with PJ, PG was associated with an increased rate of grade A/B bleeding events, perioperative stroke, less enzyme supplementation at 6 months, and improved results in some quality of life parameters. Conclusions: The rate of grade B/C fistula after PG versus PJ was not different. There were more postoperative bleeding events with PG. Perioperative morbidity and mortality of pancreatoduodenectomy seem to be underestimated, even in the high-volume center setting. |
|---|---|
| Item Description: | Gesehen am 28.02.2019 |
| Physical Description: | Online Resource |
| ISSN: | 1528-1140 |
| DOI: | 10.1097/SLA.0000000000001240 |