Journal ArticleDOI
Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial
Baki Topal,Steffen Fieuws,Raymond Aerts,Joseph Weerts,Tom Feryn,Geert Roeyen,Claude Bertrand,Catherine Hubert,Marc Janssens,Jean Closset +9 more
TLDR
In patients undergoing pancreaticoduodenectomy for pancreatic head or periampullary tumours, pancreaticogastrostomy is more efficient than pancreaticojejunostomy in reducing the incidence of postoperative pancreatic fistula.Abstract:
Summary Background Postoperative pancreatic fistula is the leading cause of death and morbidity after pancreaticoduodenectomy. However, the best reconstruction method to reduce occurrence of fistula is debated. We did a multicentre, randomised superiority trial to compare the outcomes of different reconstructive techniques in patients undergoing pancreaticoduodenectomy for pancreatic or periampullary tumours. Methods Patients aged 18–85 years with confirmed or suspected neoplasms of the pancreas, distal bile duct, ampulla vateri, duodenum, or periampullary tumours were eligible for inclusion. An internet-based platform was used to randomly assign patients to either pancreaticojejunostomy or pancreaticogastrostomy as reconstruction after pancreaticoduodenectomy, using permuted blocks with six patients per block. Within each centre the randomisation was stratified on the pancreatic duct diameter (≤3 mm vs >3 mm) measured at the time of surgery. The primary endpoint was the occurrence of clinical postoperative pancreatic fistula (grade B or C) as defined by the International Study Group on Pancreatic Fistula. The study was not masked and analyses were done by intention to treat. Patient follow-up was closed 2 months after discharge from the hospital. This study is registered with ClinicalTrials.gov, number NCT00830778. Findings Between June, 2009, and August, 2012, we randomly allocated 167 patients to receive pancreaticojejunostomy and 162 to receive pancreaticogastrostomy. 33 (19·8%) patients in the pancreaticojejunostomy group and 13 (8·0%) in the pancreaticogastrostomy group had clinical postoperative pancreatic fistula (OR 2·86, 95% CI 1·38–6·17; p=0·002). The overall incidence of postoperative complications did not differ significantly between the groups (99 in the pancreaticojejunostomy group vs 100 in the pancreaticogastrostomy group), although more events in the pancreaticojejunostomy group were of grade ≥3a than in the pancreaticogastrostomy group (39 vs 35). Interpretation In patients undergoing pancreaticoduodenectomy for pancreatic head or periampullary tumours, pancreaticogastrostomy is more efficient than pancreaticojejunostomy in reducing the incidence of postoperative pancreatic fistula. Funding Funding Johnson & Johnson Medical Devices, Belgium.read more
Citations
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Optimizing the outcomes of pancreatic cancer surgery
TL;DR: The safety and efficacy of pancreatic cancer surgery have improved considerably in the past decade, enabling perioperative mortality of around 3% and 5-year survival approaching 30–40% after resection and chemotherapy.
Journal ArticleDOI
Improvement of surgical results for pancreatic cancer.
TL;DR: With increasing evidence on surgical and perioperative aspects of pancreatic cancer therapy, short-term and long-term outcomes of resectables and borderline resectable pancreatic cancers are improving.
Journal ArticleDOI
Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767) Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial
Tobias Keck,Ulrich F. Wellner,Marcus Bahra,Fritz Klein,Olivia Sick,Marco Niedergethmann,Torsten J. Wilhelm,Stefan Farkas,T. Börner,Christiane Bruns,Axel Kleespies,Jörg Kleeff,André L. Mihaljevic,Waldemar Uhl,A. Chromik,Volker Fendrich,K. Heeger,Winfried Padberg,Andreas Hecker,Ulf P. Neumann,K. Junge,Jörg C. Kalff,Tim R. Glowka,Jens Werner,Phillip Knebel,Pompiliu Piso,M. Mayr,J. R. Izbicki,Yogesh K. Vashist,Peter Bronsert,Thomas Bruckner,Ronald Limprecht,Markus K. Diener,Inga Rossion,I. Wegener,U. T. Hopt +35 more
TL;DR: A multicenter prospective randomized controlled trial comparing pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy was conducted in this paper.
Journal ArticleDOI
Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy
Juan Figueras,Luis Sabater,P Planellas,Elena Muñoz-Forner,Santiago Lopez-Ben,L. Falgueras,C Sala-Palau,M Albiol,Joaquín Ortega-Serrano,E. Castro-Gutierrez +9 more
TL;DR: This randomized clinical trial was to test the hypothesis that invaginated PG would result in a lower rate and severity of pancreatic fistula.
Journal ArticleDOI
Pancreatic anastomosis after pancreatoduodenectomy: A position statement by the International Study Group of Pancreatic Surgery (ISGPS)
Shailesh V. Shrikhande,Masillamany Sivasanker,Charles M. Vollmer,Helmut Friess,Marc G. Besselink,Abe Fingerhut,Charles J. Yeo,Carlos Fernandez-del-Castillo,Christos Dervenis,Christoper Halloran,Dirk J. Gouma,Dejan Radenkovic,Horacio J. Asbun,John P. Neoptolemos,Jakob R. Izbicki,Keith D. Lillemoe,Kevin C. Conlon,Laureano Fernández-Cruz,Marco Montorsi,Max Bockhorn,Mustapha Adham,Richard Charnley,Ross Carter,Thilo Hackert,Werner Hartwig,Y. Miao,Michael G. Sarr,Claudio Bassi,Markus W. Büchler +28 more
TL;DR: An international panel of pancreatic surgeons working in well‐known, high‐volume centers reviewed the best contemporary literature concerning pancreatico‐enteric anastomosis and worked to develop a position statement on pancreatic anstomosis after pancreatoduodenectomy, finding no specific technique can eliminate development of clinically relevant postoperative pancreatic fistula.
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Special article Postoperative pancreatic fistula: An international study group (ISGPF) definition
Claudio Bassi,Christos Dervenis,Giovanni Butturini,Abe Fingerhut,Jakob R. Izbicki,John P. Neoptolemos,Michael G. Sarr,William Traverso,M.W. Büchler +8 more
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