In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy

Abstract

In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomyBackground: It has been suggested that pancreaticogastrostomy (PG) is a safer reconstruction than pancreaticojejunostomy (PJ), resulting in lower morbidity, including lower pancreatic leak rates and decreased postoperative mortality. We com pared PJ and PG after pancreaticoduodenectomy (PD). Methods:A randomized clinical trial was designed. It was stopped with 50% accrual. Patients underwent either PG or PJ reconstruction. The primary outcome was the pancreatic fistula rate, and the secondary outcomes were overall morbidity and mor tality. We used the Student t, Mann-Whitney U and χ 2 tests for intention to treat analysis. The effect of randomization, American Society of Anesthesiologists score, soft pancreatic texture and use of pancreatic stent on overall complications and fistula rates was calculated using logistic regression.Results: Our trial included 98 patients. The rate of pancreatic fistula formation was 18% in the PJ and 25% in the PG groups (p = 0.40). Postoperative complications occurred in 48% of patients in the PJ and 58% in the PG groups (p = 0.31). There were no significant predictors of overall complications in the multivariate analysis. Only soft pancreatic gland predicted the occurrence of pancreatic fistula (odds ratio 5.89, p = 0.003). Conclusion:There was no difference in the rates of pancreatic leak/fistula, overall complications or mortality between patients undergoing PG and and those under going PJ after PD.Contexte : Selon certains, la pancréatogastrostomie (PG) est une technique de recon struction plus sécuritaire que la pancréatojéjunostomie (PJ) et entraîne une morbidité moindre, y compris un taux moins élevé de fuites pancréatiques et une mortalité post opératoire diminuée. Nous avons comparé la PJ et la PG postpancréatoduodénectomie. Méthodes :Un essai clinique randomisé a été conçu et cessé à l'atteinte d'un taux de participation de 50 %. Les patients ont subi une reconstruction par PG ou par PJ. Le paramètre principal était le taux de fistules pancréatiques et les paramètres secondaires étaient la morbidité et la mortalité globales. Nous avons utilisé les tests t de Student, U de Mann-Whitney et du χ 2 carré pour l'analyse en intention de traiter. Nous avons cal culé l'effet de la randomisation, du score de l'American Society of Anesthesiologists, de la consistance molle du pancréas et du recours à l'endoprothèse pancréatique sur les com plications globales et les taux de fistules à l'aide d'une analyse de régression logistique.Résultats : Notre essai a regroupé 98 patients. Le taux de fistules pancréatiques a été de 18 % dans le groupe soumis à la PJ et de 25 % dans le groupe soumis à la PG (p = 0,40). Des complications postopératoires sont survenues chez 48 % des patients du groupe soumis à la PJ et chez 58 % du groupe soumis à la PG (p = 0,31). Aucun pré dicteur significatif des complications globales n'est ressorti à l'analyse multivariée. Seule l...

Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture

“…Finally, 122 studies were included. Of those 122 studies, 110 studies 3, [13][14][15][17][18][19][20][21][22][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127] were included in both qualitative synthesis and meta-analysis and 12 16,[128][129][130][131][132][133][134][135][136][137][138] only in the qualitative synthesis (eTable 2).…”

“…Classification of PT including more than 3 groups was rarely used. 3,130 The prevalence rates of soft, intermediate and hard pancreas were reported in Table 1. Of note, the terms used for "soft", "intermediate" and "hard" PT varied considerably among studies.…”

Pancreatogastrostomy versus Pancreatojejunostomy: An Up-to-Date Meta-Analysis of RCTs

“…All studies, except Duffas et al [ 22 ], had the rate of POPF as primary outcome. Four studies [ 21 , 24 , 26 , 29 ] did not report the duration of follow-up. In the other six studies, follow-up varied from 30 days to 12 months.…”

“…Only two trials [ 11 , 22 ] reported the blinding of participants and personnel and the blinding of outcome assessment. Only in the study of Grendar et al [ 26 ], incomplete outcome data and possible selective reporting were detected. There was almost perfect agreement between the two investigators (Cohen's k statistic: 82.3% P < 0.001).…”

Comparison of Different Techniques of Pancreatic Stump Management in Robot-Assisted Pancreaticoduodenectomy

“…They suggest that PG anastomosis reduces the rate and severity of POPF [34,37,[39][40][41][42]. However, other studies and randomized trials show no difference in the rates of POPF and overall complications [18,43].…”