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Dokumentenart: | Artikel | ||||
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Titel eines Journals oder einer Zeitschrift: | Annals of Surgery | ||||
Verlag: | Lippincott | ||||
Ort der Veröffentlichung: | PHILADELPHIA | ||||
Band: | 263 | ||||
Nummer des Zeitschriftenheftes oder des Kapitels: | 3 | ||||
Seitenbereich: | S. 440-449 | ||||
Datum: | 2016 | ||||
Institutionen: | Medizin > Lehrstuhl für Chirurgie | ||||
Identifikationsnummer: |
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Stichwörter / 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 | ||||
Dewey-Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin | ||||
Status: | Veröffentlicht | ||||
Begutachtet: | Ja, diese Version wurde begutachtet | ||||
An der Universität Regensburg entstanden: | Ja | ||||
Dokumenten-ID: | 41875 |
Zusammenfassung
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 ...
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Zusammenfassung
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.
Metadaten zuletzt geändert: 17 Mrz 2020 11:01