; 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. | Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Annals of Surgery | ||||
| Publisher: | Lippincott | ||||
| Place of Publication: | PHILADELPHIA | ||||
| Volume: | 263 | ||||
| Number of Issue or Book Chapter: | 3 | ||||
| Page Range: | pp. 440-449 | ||||
| Date: | 2016 | ||||
| Institutions: | Medicine > Lehrstuhl für Chirurgie | ||||
| Identification Number: |
| ||||
| 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 Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 41875 |
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 ...

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.
Metadata last modified: 17 Mar 2020 11:01
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