gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Single Center Randomized Trial of Pancreatogastrostomy versus Pancreaticojejunostomy

Meeting Abstract

  • Ulrich Friedrich Wellner - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Olivia Sick - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Frank Makowiec - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Ullrich Theodor Hopt - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Tobias Keck - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch131

DOI: 10.3205/12dgch131, URN: urn:nbn:de:0183-12dgch1317

Veröffentlicht: 23. April 2012

© 2012 Wellner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Retrospective studies and meta-analysis have shown a significant reduction of postoperative pancreatic fistula (POPF) with pancreatogastrostomy (PG) compared to pancreatojejunostomy (PJ) for reconstruction after pancreatoduodenectomy. So far only one of four randomized trials (RT) could verify this finding. In the setting of a soft pancreas, pancreatogastrostomy is associated with significantly reduced surgical complications.

Materials and methods: From 2006 to 2011, n=116 patients were randomized intraoperatively to receive a PG or PJ. PJ was performed by duct-mucosa anastomosis with pancreatic duct stenting, PG by internal pursestring and single interrupted suture via anterior and posterior gastrotomy. Primary endpoint was POPF of Grade B or C (ISGPS definition). Secondary endpoints included postpancreatectomy hemorrhage (PPH, ISGPS definition), reoperation and mortality. A planned subgroup analysis was performed for patients with critical and soft pancreas.

Results: ITT analysis comprised 59 PG and 57 PJ. Demographic and risk factors were balanced in the treatment arms. The rate of POPF B/C in the PG vs PJ arm was 12% vs 10% (p = not significant (n.s.)). In the high-risk subgroup with soft pancreas (n=64), the POPF B/C rate was lower with PG compared to PJ (24% vs 14%, p = n.s.). Postoperative bleeding rates (PPH Grade B or C) were not statistically different (PG vs PJ, 10% vs 7%, p=n.s.). Intraluminal bleeding occurred more frequently with PG (7% vs 2%, p=n.s.) and required reoperation in one patient. Mortality was very low (1.8%) in both groups and was associated with complications of POPF in patients with soft pancreata.

Conclusion: Mortality of pancreatoduodenectomy is low but still associated with complications of POPF, therefore the question of safety in pancreatoenteric anastomosis remains important. The trial did not detect a statistically significant difference between PG and PJ in terms of POPF rate but validates retrospective data including a trend towards reduced POPF in high-risk patients. These findings need to be confirmed in the setting of a high-volume randomized trial.