Clinical surgeryA controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy
Section snippets
Patients
Between September 1995 and December 1999 (ie, 52 months), 149 consecutive patients (86 men and 63 women, mean age 58.4 ± 11 years (range 22–76 years), undergoing PD, whether for pancreatic (malignant or benign) tumor or chronic pancreatitis or for extrapancreatic tumor (ampullar, biliary, or duodenal), were included in this multicenter trial. Fourteen surgical centers participated (8 university and 6 nonuniversity community hospitals). The initial and final dates of participation differed from
Results
Of 149 patients randomized, 81 underwent PG and 68 underwent PJ. There were no protocol violations, no crossovers, or withdrawals after randomization.
Comments
Our study shows that the type of pancreatoenteric anastomosis (PJ or PG) after PD does not statistically significantly influence either the rate of patients with one or more IACs, the rate of pancreatoenteric fistula, or the severity of complications (Table 3). In multivariate analysis, 2 independent risk factors were found: duration of operation longer than 6 hours (P = .01) and age ≥70 years (P < .02).
Our multicenter study confirmed the results of the only other monocenter, randomized trial
Conclusion
As suggested by the results of our study and those of Yeo et al [11], the best anastomosis after PD is probably the one with which the surgeon is most familiar. The multicenter character of our study confers wide applicability of results to nonspecialized, low-volume settings. In the future, the following technical artifices that might lower the rate of postoperative IAC and in particular of pancreatic fistula remain to be evaluated by randomized trials: preoperative radiation therapy [19], [23]
References (41)
- et al.
Efficacy of octreotide in the prevention of complication fistula after elective pancreatic resections. A prospective, controlled randomized trial
Surgery
(1995) - et al.
Role of octreotide in the prevention of postoperative complications following pancreatic resections
Am J Surg
(1992) - et al.
Hospital volume and surgical mortality in the United States
N Engl J Med
(2002) - et al.
Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy
Ann Surg
(2003) - et al.
Survival after pancreaticoduodenectomy118 consecutive resections without an operative mortality
Ann Surg
(1990) - et al.
One hundred and forty five consecutive pancreatico-duodenectomies without mortality
Ann Surg
(1993) - et al.
Decreased morbidity and mortaltiy after the Whipple procedure
Ann Surg
(1992) - et al.
Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis
Br J Surg
(1995) - et al.
Efficacy of octreotide in the prevention of complications of elective pancreatic surgery
Br J Surg
(1994) - et al.
Complications following pancreaticoduodenectomycurrent management
Arch Surg
(1992)
The potent somatostatin analogue Vapreotide does not decrease pancreas-specific complications after elective pancreatectomyA prospective, multicenter, double-blinded, randomized, placebo-controlled trial
J Am Coll Surg
A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy
Ann Surg
The Whipple resection for cancer in U.S. Department of Veterans Affairs hospital
Ann Surg
Pancreatic fistula complicating pancreatectomy for malignant disease
Br J Surg
Six hundred fifty consecutive pancreaticoduodenectomies in the 1990’sPathology, complications and outcomes
Ann Surg
Incidence, risk factors and treatment of pancreatic leakage after pancreaticoduodenectomyDrainage versus resection of the pancreatic remnant
J Am Coll Surg
Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection. A prospective, multicenter, randomized clinical trial
Arch Surg
Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomyResults of a prospective randomized placebo-controlled trial
Ann Surg
Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreatoduodenectomy
Arch Surg
Stented versus non-stented pancreaticojejunostomy after pancreaticoduodenectomy
Ann Surg
Cited by (241)
In Whipple's procedure, which anastomotic technique has lower leak rate; Pancreaticogastostomy or Pancreatojejunostomy?
2021, Annals of Medicine and SurgeryUse of routine CT-SCANS to detect severe postoperative complications after pancreato-duodenectomy
2018, Journal of Visceral Surgery
A complete list of the collaborators in the French Associations for Research in Surgery appears in Appendix 1.