Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767)

Keck, Tobias; Wellner, Ulrich; Bahra, Marcus; Klein, Fritz; Sick, Olivia; Niedergethmann, Marco; Wilhelm, T; Farkas, S.; Börner, Thomas; Bruns, Christiane; Kleespies, Axel; Kleeff, Jörg; Mihaljevic, André L.; Uhl, Waldemar; Chromik, Ansgar M.; Fendrich, Volker; Heeger, Kristin; Padberg, Winfried; Hecker, Andreas; Neumann, Ulf; Junge, K.; Kalff, Jörg C.; Glowka, Tim R.; Werner, Jens; Knebel, Phillip; Piso, Pompiliu; Mayr, Martina; Izbicki, Jakob R.; Vashist, Yogesh K.; Bronsert, Peter; Brückner, Thomas; Limprecht, Ronald; Diener, Markus K.; Rossion, Inga; Wegener, I.; Hopt, Ulrich T.

doi:10.1097/sla.0000000000001240

Cited by 284 publications

(203 citation statements)

References 52 publications

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“…Since then, differences in perioperative parameters and postoperative outcomes of classic PD compared to pylorus-preserving PD have been investigated in numerous studies. Avoiding stomach resection without constraining lymph node clearance, pylorus-preserving PD has gained popularity over the classic Whipple procedure in many centers (11,12).…”

Section: Introductionmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons.After its oncological adequacy was questioned initially, pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that pylorus resection does not reduce DGE compared to the pyloruspreserving operation. Non-superiority of pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without pylorus preservation and derives recommendations for daily practice.

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Section: Introductionmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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“…The incidence of POPF is still high at 10%-22% after PD and at 30% after distal pancreatectomies, even in highvolume centers [17][18][19][20]. In the present study, the rate of POPF was 11.52%.…”

Section: Discussionmentioning

confidence: 52%

Is Sutureless Pancreaticogastrostomy More Effective than Single-Layer Duct-to-Mucosa Pancreaticojejunostomy in Pancreaticoduodenectomy?

Kostov

Kobakov

2017

Eurasian J Med

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Objective: The present study aimed to assess the safety of pancreatic anastomosis after pancreaticoduodenectomy (PD) and to compare the results of sutureless pancreatogastrostomy (PG) with those of single-layer duct-to-mucosa pancreatojejunostomy (PJ) after PD in patients with malignant disease of the pancreatic head and of the periampullary region. Materials and Methods:The study included 173 consecutive patients undergoing PD from May 2009 to December 2015 at a single surgical center. Single-layer duct-to-mucosa PJ was performed in 52 patients and sutureless PG in the remaining 123. The primary endpoint was the safety of the procedures, which was assessed as the occurrence of complications during hospitalization. Postoperative pancreatic fistula (POPF) was classified as grade A, B, or C according to the International Study Group of Pancreatic Fistula classification.Results: We found that the incidence of POPF was 11.52%. With regard to POPF, the present study showed no significant difference in the two groups (p=0.043). The incidence of Grade C POPF was significantly higher in the PJ group than in the PG group (p=0.001), which was been reflected in the form of a higher rate of postoperative hemorrhage (p=0.001), intra-abdominal abscess (p=0.012), and septic shock (p=0.012) events in the PJ group. Conclusion:The evaluation of short-term outcomes demonstrates that suturelessPG is a feasible and safe technique, associated with lower life-threatening complications than single-layer duct-to-mucosa PJ. If longterm functional outcomes confirm similar results, sutureless PG could become a valid alternative for pancreatic anastomosis after PD in patients with soft pancreas and high morbidity. Bulgular: Çalışmamızda POPF oranı %11,52 olarak bulundu. İki grup arasında anlamlı bir farklılık görülmedi (p=0,043). Evre C POPF insidansı PJ' de PG grubuna göre anlamlı ölçüde daha yüksekti (p=0,001), Ayrıca PJ grubunda postoperatif hemoraji (p=0,001), intraabdominal apse (p=0,012) ve septik şok (p=0,012) vakalarının oranları da daha yüksek bulundu.Sonuç: Kısa dönem sonuçların değerlendirilmesine göre, tek katlı duct-to-mukozal PJ ile kıyaslandığında dikiş-siz PG daha düşük oranda yaşamı tehdit eden komplikasyonlarından dolayı uygulanabilir ve güvenli bir tekniktir. Uzun dönem fonksiyonel sonuçlarla benzer bulgular doğrulandığı takdirde dikişsiz PG, yumuşak yapılı pankreası ve yüksek morbiditesi olan hastalarda PD sonrası pankreatik anastomoz için geçerli bir alternatif olabilir.

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“…Regarding long-term pancreatic function between PJ and PG, two RCT have demonstrated that pancreatic exocrine insufficiency is more severe after PJ than PG (23,25). In contrast, one RCT has reported conflicting long-term outcomes regarding pancreatic function (24).…”

Section: Pj Versus Pgmentioning

confidence: 99%

“…There were nine RCTs to examine that PG reduces the incidence of pancreatic fistula comparing PJ ( Table 1) (17)(18)(19)(20)(21)(22)(23)(24)(25). Afterward, a multicenter prospective randomized controlled trial comparing PG with PJ from Germany was published in 2015 (25). The impact of study was the currently largest (n=440) multicenter prospective randomized controlled trial comparing PG with PJ regarding postoperative complications including pancreatic fistula and long-term pancreatic function.…”

Section: Pj Versus Pgmentioning

confidence: 99%

“…However, there are some limitations in this meta-analysis as follows; (I) the type of intervention and the indications for surgery which are different among seven RCTs may lead to different results; (II) the definition of pancreatic fistula varied among these RCTs may cause the different decision of pancreatic fistula among each institution. There were nine RCTs to examine that PG reduces the incidence of pancreatic fistula comparing PJ ( Table 1) (17)(18)(19)(20)(21)(22)(23)(24)(25). Afterward, a multicenter prospective randomized controlled trial comparing PG with PJ from Germany was published in 2015 (25).…”

Section: Pj Versus Pgmentioning

confidence: 99%

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Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

Kitahata¹,

Kawai²,

Yamaue³

2016

Transl. Gastroenterol. Hepatol.

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Pancreatic fistula is one of severe postoperative complications that occur after pancreatic surgery, such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). Because pancreatic fistula is associated with a higher incidence of life-threatening complications. In order to evaluate procedure or postoperative management to reduce pancreatic fistula after pancreatic surgery, we summarized some randomized controlled trials (RCTs) regarding pancreaticoenterostomy during PD, pancreatic duct stent during PD, procedure to resect pancreatic parenchyma during DP, and somatostatin and somatostatin analogues after pancreatic surgery.At first, we reviewed nine RCTs to compare pancreaticogastrostomy (PG) with pancreaticojejunostomy (PJ) during PD. Next, we reviewed five RCTs, to evaluate the impact of pancreatic duct stent during PD. Regarding DP, we reviewed six RCTs to evaluate appropriate procedure to reduce pancreatic fistula after DP. Finally, we reviewed eight RCTs to evaluate the impact of somatostatin and somatostatin analogues after pancreatic surgery to reduce pancreatic fistula. The best way to prevent pancreatic fistula after pancreatic surgery remains still controversial. However, several RCTs clarify a useful procedure to reduce in reducing the incidence of pancreatic fistula after pancreatic surgery. Further RCTs to study innovative approaches remain a high priority for pancreatic surgeons to prevent pancreatic fistula after pancreatic surgery.

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Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767)

Cited by 284 publications

References 52 publications

Pylorus preservation pancreatectomy or not

Pylorus preservation pancreatectomy or not

Is Sutureless Pancreaticogastrostomy More Effective than Single-Layer Duct-to-Mucosa Pancreaticojejunostomy in Pancreaticoduodenectomy?

Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

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