Influence of the Retrocolic Versus Antecolic Route for Alimentary Tract Reconstruction on Delayed Gastric Emptying After Pancreatoduodenectomy

Abstract

Objective:This study aimed to determine whether retrocolic alimentary tract reconstruction is noninferior to antecolic reconstruction in terms of DGE incidence after pancreatoduodenectomy (PD) and investigated patients’ postoperative nutritional status.Summary of Background Data:The influence of the route of alimentary tract reconstruction on DGE after PD is controversial.Methods:Patients from 9 participating institutions scheduled for PD were randomly allocated to the retrocolic or antecolic reconstruction groups. The primary outcome was incidence of DGE, defined according to the 2007 version of the International Study Group for Pancreatic Surgery definition. Noninferiority would be indicated if the incidence of DGE in the retrocolic group did not exceed that in the antecolic group by a margin of 10%. Patients’ postoperative nutrition data were compared as secondary outcomes.Results:Total, 109 and 103 patients were allocated to the retrocolic and antecolic reconstruction group, respectively (n = 212). Baseline characteristics were similar between both groups. DGE occurred in 17 (15.6%) and 13 (12.6%) patients in the retrocolic and antecolic group, respectively (risk difference; 2.97%, 95% confidence interval; −6.3% to 12.6%, which exceeded the specified margin of 10%). There were no differences in the incidence of other postoperative complications and in the duration of hospitalization. Postoperative nutritional indices were similar between both groups.Conclusions:This trial could not demonstrate the noninferiority of retrocolic to antecolic alimentary tract reconstruction in terms of DGE incidence. The alimentary tract should not be reconstructed via the retrocolic route after PD, to prevent DGE.

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

“…Ages, gender mix and BMI were generally comparable between direct comparisons, although the single study comparing PR, retrocolic, Billroth II against PR, antecolic Billroth II had a male-predominant cohort (more than 70 per cent). Most studies were conducted in Asia (16 of 24; 67 per cent) 5 , 35 , 36 , 38–46 , 48 , 50 , 51 , 53 , 10 of which were in Japan 5 , 35 , 36 , 39 , 42 , 44 , 46 , 48 , 50 , 51 . Study characteristics are summarized in Table S1 .…”

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials

“…Similarly, 15 studies used the ISGPF definition for POPF. Only five studies reported the rates of prokinetic use after PD 2–5,38 . Only three studies reported rates of parenteral nutrition (30-45%), with no differences between comparator arms 3,39,40 .…”

“…Ages, gender mix and BMI were generally comparable between direct comparisons, however, the single study comparing PR, retrocolic, Billroth II against PR, antecolic Billroth II had a male predominant cohort (>70%). Most studies were conducted in Asia (16/24; 67%) 38,39,41–54 , 10 of which were in Japan 41–43,46,47,49–53 . Study characteristics are summarised in Table S1 .…”

“…Analysis of clinically relevant DGE (defined as Grade B or C 27 ), could not be performed due to insufficient studies. Three studies had some degree of cross-over between PP and CW arms, in particular in Eshuis et al 2,5,63 . One study that would otherwise have met the inclusion criteria for this NMA was excluded due to patients being stratified to either CW or PP in both arms (comparing antecolic vs retrocolic routes), with breakdown of data unavailable upon contacting authors.…”

“…Pancreaticoduodenectomy (PD) is commonly performed for benign and malignant pancreatic head and periampullary disease. There remains a high prevalence of postoperative delayed gastric emptying (DGE), affecting between 10-45% of patients 1–5 . DGE is associated with poorer quality of life 6 , increased hospital length of stay 7 , readmissions 8 and healthcare costs 9,10 .…”