Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767)

• Verfasst von: Keck, Tobias [VerfasserIn]
• Verfasst von: Niedergethmann, Marco [VerfasserIn]
• Verfasst von: Wilhelm, Torsten [VerfasserIn]
• Verfasst von: Werner, Jens [VerfasserIn]
• Verfasst von: Knebel, Phillip [VerfasserIn]
• Verfasst von: Bruckner, Thomas [VerfasserIn]
• Titel: Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767)
• Titelzusatz: perioperative and long-term results of a multicenter randomized controlled trial
• Verf.angabe: 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
• E-Jahr: 2016
• Jahr: March 2016
• Umfang: 10 S.
• Fussnoten: Gesehen am 28.02.2019
• Titel Quelle: Enthalten in: Annals of surgery
• Ort Quelle: [Erscheinungsort nicht ermittelbar] : Lippincott Williams & Wilkins, 1885
• Jahr Quelle: 2016
• Band/Heft Quelle: 263(2016), 3, Seite 440-449
• ISSN Quelle: 1528-1140
• DOI: doi:10.1097/SLA.0000000000001240
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1588234398

Abstract

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.