Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial
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Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial. / Keck, Tobias; Wellner, U F; Bahra, M; Klein, F; Sick, O; Niedergethmann, M; Wilhelm, T J; Farkas, S A; Börner, T; Bruns, C; Kleespies, A; Kleeff, J; Mihaljevic, A L; Uhl, W; Chromik, A; Fendrich, V; Heeger, K; Padberg, W; Hecker, A; Neumann, U P; Junge, K; Kalff, J C; Glowka, T R; Werner, J; Knebel, P; Piso, P; Mayr, M; Izbicki, J; Vashist, Y; Bronsert, P; Bruckner, T; Limprecht, R; Diener, M K; Rossion, I; Wegener, I; Hopt, U T.
In: ANN SURG, Vol. 263, No. 3, 04.12.2015, p. 440-9.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial
AU - Keck, Tobias
AU - Wellner, U F
AU - Bahra, M
AU - Klein, F
AU - Sick, O
AU - Niedergethmann, M
AU - Wilhelm, T J
AU - Farkas, S A
AU - Börner, T
AU - Bruns, C
AU - Kleespies, A
AU - Kleeff, J
AU - Mihaljevic, A L
AU - Uhl, W
AU - Chromik, A
AU - Fendrich, V
AU - Heeger, K
AU - Padberg, W
AU - Hecker, A
AU - Neumann, U P
AU - Junge, K
AU - Kalff, J C
AU - Glowka, T R
AU - Werner, J
AU - Knebel, P
AU - Piso, P
AU - Mayr, M
AU - Izbicki, J
AU - Vashist, Y
AU - Bronsert, P
AU - Bruckner, T
AU - Limprecht, R
AU - Diener, M K
AU - Rossion, I
AU - Wegener, I
AU - Hopt, U T
PY - 2015/12/4
Y1 - 2015/12/4
N2 - 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.
AB - 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.
U2 - 10.1097/SLA.0000000000001240
DO - 10.1097/SLA.0000000000001240
M3 - SCORING: Journal article
C2 - 26135690
VL - 263
SP - 440
EP - 449
JO - ANN SURG
JF - ANN SURG
SN - 0003-4932
IS - 3
ER -