Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial.

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.

• Authors: Tobias Keck, U F Wellner, M Bahra, F Klein, O Sick, M Niedergethmann, T J Wilhelm, S A Farkas, T Börner, C Bruns, A Kleespies, J Kleeff, A L Mihaljevic, W Uhl, A Chromik, V Fendrich, K Heeger, W Padberg, A Hecker, U P Neumann, K Junge, J C Kalff, T R Glowka, J Werner, P Knebel, P Piso, M Mayr, J Izbicki, Y Vashist, P Bronsert, T Bruckner, R Limprecht, M K Diener, I Rossion, I Wegener, U T Hopt
• Journal: Annals of surgery (Ann Surg) Vol. 263 Issue 3 Pg. 440-9 (Mar 2016) ISSN: 1528-1140 [Electronic] United States
• PMID: 26135690 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Germany (epidemiology)
• Hemorrhage (epidemiology)
• Hospital Mortality
• Humans
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Pancreatic Diseases (mortality, surgery)
• Pancreatic Fistula (epidemiology)
• Pancreaticoduodenectomy
• Pancreaticojejunostomy
• Postoperative Complications (epidemiology, mortality)
• Prospective Studies
• Quality of Life
• Risk Factors