Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial

Diener, Markus K.; Hüttner, Felix J; Kieser, Meinhard; Knebel, Phillip; Dörr-Harim, Colette; Distler, Marius; Grützmann, Robert; Wittel, Uwe A.; Schirren, Rebekka; Hau, Hans-Michael; Kleespies, Axel; Heidecke, Claus–Dieter; Tomažič, Aleš; Halloran, Christopher; Wilhelm, T; Bahra, Marcus; Beckurts, T.; Börner, Thomas; Glanemann, Matthias; Steger, Ulrich; Treitschke, Frank; Staib, Ludger; Thelen, Karsten; Brückner, Thomas; Mihaljevic, André L.; Werner, Jens; Ulrich, Alexis; Hackert, Thilo; Büchler, Markus W.; Rossion, Inga; Kunz, Alexandra; Hund, Evelin; Limprecht, Ronald; Schlitt, Hans J.; Mössner, Joachim; Seiler, Christoph M.; Ihorst, Gabriele; Sebastiano, Pierluigi di; Witzigmann, Helmut; Klein, Fritz; Berthold, Heike; Körnlein, Heike; Hopt, Ulrich T.; Sick, Olivia; Keck, Tobias; Partecke, Lars Ivo; Peters, Sebastian; Lerch, Markus M.; Maichle, Barbara; Erni, Birgit; Bunjes-Schmieger, Sabine; Igel, Sarah; Stemmle, Svenja; Neoptolemos, John P.; Raraty, Michael; Petrič, Miha; Niedergethmann, Marco; Schwarzmeier, Claudia; Renz, Bernhard W.; Schreib, Brigitte; Thasler, Wolfgang E.; Schoenberg, M. H.; Frieß, Helmut; Reim, Daniel; Ceyhan, Güralp O.; Diehl-Bein, Monika; Simon, Thomas; Gehrig, Tobias; Hoffer, Marion; Germer, Christoph T.

doi:10.1016/s0140-6736(17)31960-8

Cited by 129 publications

(84 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the second scenario of the older patient with large duct disease but with a pancreatic head mass, pancreaticoduodenectomy was the favoured option, it being selected by 51%. This response is broadly in keeping with the evidence from the ChroPac trial, which did not show superiority of duodenum-preserving pancreatic head resection compared to pancreaticoduodenectomy [9]…”

Section: Discussionsupporting

confidence: 73%

The Practical Management of Chronic Pancreatitis: A Multidisciplinary Symposium Held at the Annual Meeting of the Pancreatic Society of Great Britain and Ireland, Manchester 2016

Jegatheeswaran¹,

Puleston

Duggan

et al. 2018

Dig Surg

View full text Add to dashboard Cite

Aim: This study is about a questionnaire survey of delegates attending the chronic pancreatitis symposium at the 2016 meeting of the Pancreatic Society of Great Britain and Ireland and seeks a multidisciplinary “snapshot” overview of practice. Methods: A questionnaire was developed with multidisciplinary input. Questions on access to specialist care, methods of diagnosis and treatment including specific scenarios were incorporated. Eighty-three (66%) of 125 delegates effectively participated in this survey. Results: Twenty-four (29%) had neither a chronic pancreatitis MDT in their hospital nor a chronic pancreatitis referral MDT. Most frequently utilised diagnostic modalities were CT, MR and EUS with no respondents utilising duodenal intubation tests. Initial treatment was provided through non-opiate analgesia by 69 (93%), through the use of opiates by 56 (76%) and through the use of co-analgesics by 49 (66%). Fifty two (68%) routinely referred patients with alcohol-related disease for counselling. Preferred treatment for large duct disease without mass was endoscopic therapy. In older patients with a mass, pancreaticoduodenectomy was preferred. Conclusion: This is a small study likely to be skewed by sampling bias but is thought to be the first multidisciplinary survey of the management of chronic pancreatitis in the United Kingdom and Ireland. The results show a need for comprehensive access to specialist pancreatitis MDT care and there remains substantial variation in management.

show abstract

Section: Discussionsupporting

confidence: 73%

The Practical Management of Chronic Pancreatitis: A Multidisciplinary Symposium Held at the Annual Meeting of the Pancreatic Society of Great Britain and Ireland, Manchester 2016

Jegatheeswaran¹,

Puleston

Duggan

et al. 2018

Dig Surg

View full text Add to dashboard Cite

show abstract

“…Several variations of the classical Whipple procedure have been described in adults . However, experience with these techniques is limited in pediatric pancreatic surgery.…”

Section: Discussionmentioning

confidence: 99%

Solid pseudopapillary and malignant pancreatic tumors in childhood: A systematic review and evidence quality assessment

Mylonas

Doulamis²,

Tsilimigras

et al. 2018

Pediatric Blood & Cancer

View full text Add to dashboard Cite

A systematic review of 32 studies reporting on 489 children with pancreatic tumors was performed. The most prevalent histologic subtype was solid pseudopapillary tumor (SPT) (61.3%). Pancreaticoduodenectomy was the most commonly performed operation (48%). Neoadjuvant chemo/radiotherapy was utilized in 3.9, 36.2, 25, and 27.8% of patients with SPTs, pancreatoblastomas (PBLs), neuroendocrine tumors, and exocrine carcinomas, respectively. Adjuvant chemotherapy (75.6%) and radiation (34%) were most commonly utilized in PBLs. All-cause mortality was highest in exocrine carcinomas (50%). Overall, 98.8% of patients with SPTs survived. PBL exhibited the highest recurrence rate (14.7%) within a mean of 23.5 months.

show abstract

“…Since then, differences in perioperative parameters and postoperative outcomes of classic PD compared to pylorus-preserving PD have been investigated in numerous studies. Avoiding stomach resection without constraining lymph node clearance, pylorus-preserving PD has gained popularity over the classic Whipple procedure in many centers (11,12).…”

Section: Introductionmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

Self Cite

View full text Add to dashboard Cite

Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons.After its oncological adequacy was questioned initially, pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that pylorus resection does not reduce DGE compared to the pyloruspreserving operation. Non-superiority of pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without pylorus preservation and derives recommendations for daily practice.

show abstract

Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial

Cited by 129 publications

References 35 publications

The Practical Management of Chronic Pancreatitis: A Multidisciplinary Symposium Held at the Annual Meeting of the Pancreatic Society of Great Britain and Ireland, Manchester 2016

The Practical Management of Chronic Pancreatitis: A Multidisciplinary Symposium Held at the Annual Meeting of the Pancreatic Society of Great Britain and Ireland, Manchester 2016

Solid pseudopapillary and malignant pancreatic tumors in childhood: A systematic review and evidence quality assessment

Pylorus preservation pancreatectomy or not

Contact Info

Product

Resources

About