Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial.
نویسندگان
چکیده
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.
منابع مشابه
Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after partial PANCreatoduodenectomy (RECOPANC): study protocol of a randomized controlled trial UTN U1111-1117-9588
BACKGROUND Pancreatoduodenectomy is one of the most complex abdominal operations, usually performed for tumors of the periampullary region and chronic pancreatitis. Leakage of pancreatic juice from the pancreatoenteric anastomosis, called postoperative pancreatic fistula, is the most prominent postoperative complication. Retrospective studies show a significant reduction of fistula rates with p...
متن کاملPancreatogastrostomy - History and Current Evidence
Two anastomotic techniques are available for reconstruction after pancreatoduodenectomy: pancreatojejunostomy, which is the traditional and most widely used technique, and pancreatogastrostomy. The latter was introduced into clinical practice more than 50 years ago, and has recently received increasing attention due to favorable outcome when compared to pancreatojejunostomy in randomized contro...
متن کاملLateral Pancreatogastrostomy for Stenotic Pancreatojejunostomy After Pancreatoduodenectomy: A Case Report
There is a large body of literature that describes the short-term complications (e.g., pancreatic or biliary anastomotic leaks) that occur after PD, but little has been published regarding long-term anastomotic complications. Stenosis of the anastomosis is often asymptomatic but symptomatic and painful presentations are difficult to treat, and the optimal treatment is not currently defined. The...
متن کاملThe reconstruction after pylorus preserving pancreatoduodenectomy: pancreatogastrostomy with Roux-en-Y reconstruction versus conventional Traverso type reconstruction
Objective: To compare the result of pancreatogastrostomy (PG) with Roux-en-Y reconstruction versus pancreatojejunostomy (PJ) with conventional Traverso-type reconstruction following pylorus-preserving pancreatectomy (PPPD) in a retrospective study. PPPD has been accepted as a radical surgical treatment for malignant periampullary neoplasms. However, the reconstruction of this surgery is technic...
متن کاملA new feasible technique of mesh-reinforced pancreatojejunostomy and pancreatogastrostomy: retrospective analysis of 61 cases
BACKGROUND Pancreatic leak was the major concern after pancreatoduodenectomy. METHODS A total of 61 patients who underwent mesh-reinforced pancreatojejunostomy or pancreatogastrostomy from August 2005 to November 2011 were retrospectively analyzed. RESULTS The mean anastomosis time of mesh-reinforced pancreatojejunostomy was 25 minutes ranging from 22 to 35 minutes. In mesh-reinforced pancr...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Annals of surgery
دوره 263 3 شماره
صفحات -
تاریخ انتشار 2016