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Randomized Controlled Trial
. 2016 Mar;263(3):440-9.
doi: 10.1097/SLA.0000000000001240.

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

Tobias Keck  1 , 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
Affiliations
Randomized Controlled Trial

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

Tobias Keck et al. Ann Surg. 2016 Mar.

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.

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Figures

FIGURE 1
FIGURE 1
Trial flow chart. ITT indicates intention to treat; PP, per protocol.
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