Keck, Tobias and Wellner, U. F. and Bahra, M. and Klein, F. and Sick, O. and Niedergethmann, M. and Wilhelm, T. J. and Farkas, S. A. and Boerner, T. and Bruns, C. and Kleespies, A. and Kleeff, J. and Mihaljevic, A. L. and Uhl, W. and Chromik, A. and Fendrich, V. and Heeger, K. and Padberg, W. and Hecker, A. and Neumann, U. P. and Junge, K. and Kalff, J. C. and Glowka, T. R. and Werner, J. and Knebel, P. and Piso, P. and Mayr, M. and Izbicki, J. and Vashist, Y. and Bronsert, P. and Bruckner, T. and Limprecht, R. and Diener, M. K. and Rossion, I. and Wegener, I. and Hopt, U. T. (2016) Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767) Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial. ANNALS OF SURGERY, 263 (3). pp. 440-449. ISSN 0003-4932, 1528-1140
Full text not available from this repository. (Request a copy)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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | POSTOPERATIVE PANCREATIC FISTULA; INTERNATIONAL STUDY-GROUP; PYLORUS-PRESERVING PANCREATICODUODENECTOMY; UNDERSTANDING HOSPITAL READMISSIONS; ISGPF CLASSIFICATION SCHEME; SURGERY ISGPS; RISK-FACTORS; DISTAL PANCREATECTOMY; CLINICAL-TRIALS; SCORING-SYSTEM; pancreatoduodenectomy; pancreatogastrostomy; pancreatojejunostomy; postoperative pancreatic fistula; postoperative pancreatic function |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 11 Mar 2019 14:17 |
| Last Modified: | 11 Mar 2019 14:17 |
| URI: | https://pred.uni-regensburg.de/id/eprint/2362 |
Actions (login required)
 |
View Item |
