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Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy regarding incidence of delayed gastric emptying after pancreaticoduodenectomy

  • Controlled Clinical Trials
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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Delayed gastric emptying (DGE) is an important postoperative complication after pancreaticoduodenectomy (PD), and its incidence may be associated with the utilized surgical procedures. Compared with pancreaticojejunostomy (PJ) after PD, it may be speculated that pancreaticogastrostomy (PG) is a risk factor for DGE, because it needs an anastomosis of the remnant pancreas to the back wall of the stomach. This study aimed to compare PG and PJ with regard to the incidence of DGE after PD.

Methods

We performed a prospective open-label randomized clinical trial (RCT) including patients undergoing elective pancreaticoduodenectomy, who were randomly assigned PG or PJ the day before surgery. The primary endpoint was incidence of DGE.

Results

The study included 60 patients (30 PG, 30 PJ), of whom seven were deemed unresectable, one was enucleated, and one was switched from PJ to PG during surgery according to the surgeon’s decision. Thus, modified intention-to-treat analyses were performed in 27 PG patients and 26 PJ patients. DGE occurred in three patients in the PG group and six patients in the PJ group, which did not constitute a significant between-group difference (P = 0.42). In the PG group, two cases were ISGPS grade A DGE and one was grade C. In the PJ group, one case was grade A, two grade B, and three grade C. The two groups also did not significantly differ in the incidence of other morbidities or postoperative hospital stay.

Conclusions

Post-PD DGE incidences were similar after PG and PJ.

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Abbreviations

RCT:

Randomized clinical trial

PG:

Pancreaticogastrostomy

PJ:

Pancreaticojejunostomy

DGE:

Delayed gastric emptying

PD:

Pancreaticoduodenectomy

POPF:

Postoperative pancreatic fistula

ISGPS:

International Study Group of Pancreatic Surgery

ISGPF:

International Study Group of Pancreatic Fistula

References

  1. Kimura W, Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, Shimada M, Baba H, Tomita N, Nakagoe T, Sugihara K, Mori M (2014) A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259:773–780. https://doi.org/10.1097/sla.0000000000000263

    Article  PubMed  Google Scholar 

  2. Peparini N (2016) Preventing delayed gastric emptying after pancreaticoduodenectomy. Ann Surg 263:e52. https://doi.org/10.1097/SLA.0000000000000900

    Article  PubMed  Google Scholar 

  3. Panwar R, Pal S (2017) The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int 16:353–363. https://doi.org/10.1016/S1499-3872(1017)60037-60037

    Article  PubMed  Google Scholar 

  4. Hanna MM, Gadde R, Allen CJ, Meizoso JP, Sleeman D, Livingstone AS, Merchant N, Yakoub D (2016) Delayed gastric emptying after pancreaticoduodenectomy. J Surg Res 202:380–388. https://doi.org/10.1016/j.jss.2015.12.053

    Article  PubMed  Google Scholar 

  5. Lyu Y, Li T, Cheng Y, Wang B, Chen L, Zhao S (2018) Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: an up-to-date meta-analysis of RCTs applying the ISGPS (2016) criteria. Surg Laparosc Endosc Percutan Tech:1. https://doi.org/10.1097/sle.0000000000000530

  6. Qin H, Luo L, Zhu Z, Huang J (2016) Pancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. A meta-analysis of randomized controlled trials. Int J Surg (London, England). https://doi.org/10.1016/j.ijsu.2016.10.020

  7. Zhang X, Ma L, Gao X, Bao H, Liu P, Aziz A, Wang Z, Gong P (2015) Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Surg Today 45:585–594. https://doi.org/10.1007/s00595-014-1030-1

    Article  PubMed  Google Scholar 

  8. Fernandez-Cruz L, Cosa R, Blanco L, Lopez-Boado MA, Astudillo E (2008) Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg 248:930–938. https://doi.org/10.1097/SLA.0b013e31818fefc7

    Article  PubMed  Google Scholar 

  9. Wellner UF, Sick O, Olschewski M, Adam U, Hopt UT, Keck T (2012) Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J Gastrointest Surg 16:1686–1695. https://doi.org/10.1007/s11605-012-1940-4

    Article  PubMed  Google Scholar 

  10. Topal B, Fieuws S, Aerts R, Weerts J, Feryn T, Roeyen G, Bertrand C, Hubert C, Janssens M, Closset J (2013) Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol 14:655–662. https://doi.org/10.1016/s1470-2045(13)70126-8

    Article  PubMed  Google Scholar 

  11. Figueras J, Sabater L, Planellas P, Munoz-Forner E, Lopez-Ben S, Falgueras L, Sala-Palau C, Albiol M, Ortega-Serrano J, Castro-Gutierrez E (2013) Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg 100:1597–1605. https://doi.org/10.1002/bjs.9252

    Article  CAS  PubMed  Google Scholar 

  12. El Nakeeb A, Hamdy E, Sultan AM, Salah T, Askr W, Ezzat H, Said M, Zeied MA, Abdallah T (2014) Isolated Roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study. HPB 16:713–722. https://doi.org/10.1111/hpb.12210

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grendar J, Ouellet JF, Sutherland FR, Bathe OF, Ball CG, Dixon E (2015) In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy. Can J Surg 58:154–159. https://doi.org/10.1503/cjs.010014

    Article  PubMed  PubMed Central  Google Scholar 

  14. Keck T, Wellner UF, Bahra M, Klein F, Sick O, Niedergethmann M, Wilhelm TJ, Farkas SA, Borner T, Bruns C, Kleespies A, Kleeff J, Mihaljevic AL, Uhl W, Chromik A, Fendrich V, Heeger K, Padberg W, Hecker A, Neumann UP, Junge K, Kalff JC, Glowka TR, Werner J, Knebel P, Piso P, Mayr M, Izbicki J, Vashist Y, Bronsert P, Bruckner T, Limprecht R, Diener MK, Rossion I, Wegener I, Hopt UT (2016) Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg 263:440–449. https://doi.org/10.1097/sla.0000000000001240

    Article  PubMed  Google Scholar 

  15. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 142:761–768. https://doi.org/10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  16. Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R, Bacchion M, Pederzoli P, Bassi C (2010) Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB 12:610–618. https://doi.org/10.1111/j.1477-2574.2010.00203.x

    Article  PubMed  PubMed Central  Google Scholar 

  17. Probst P, Zaschke S, Heger P, Harnoss JC, Hüttner FJ, Mihaljevic AL, Knebel P, Diener MK (2019) Evidence-based recommendations for blinding in surgical trials. Langenbecks Arch Surg 404:273–284. https://doi.org/10.1007/s00423-00019-01761-00426

    Article  PubMed  Google Scholar 

  18. Ohigashi H, Ishikawa O, Eguchi H, Sasaki Y, Yamada T, Kishi K, Noura S, Takachi K, Miyashiro I, Oue M, Yano M, Imaoka S (2008) A simple and safe anastomosis in pancreaticogastrostomy using mattress sutures. Am J Surg 196:130–134. https://doi.org/10.1016/j.amjsurg.2007.03.017

    Article  PubMed  Google Scholar 

  19. Kakita A, Takahashi T, Yoshida M, Furuta K (1996) A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today 26:532–535

    Article  CAS  PubMed  Google Scholar 

  20. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 138:8–13. https://doi.org/10.1016/j.surg.2005.05.001

    Article  PubMed  Google Scholar 

  21. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 161:584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  PubMed  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W (2005 Dec) Pederzoli P (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242:767–771

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kawai M, Yamaue H (2010) Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today 40:1011–1017. https://doi.org/10.1007/s00595-00009-04245-00599

    Article  PubMed  Google Scholar 

  25. Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, Yamaue H (2006) Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg 243:316–320. https://doi.org/10.1097/01.sla.0000201479.84934.ca

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schorn S, Demir IE, Vogel T, Schirren R, Reim D, Wilhelm D, Friess H, Ceyhan GO (2019) Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy-a systematic review with meta-analysis. Langenbecks Arch Surg 404:141–157. https://doi.org/10.1007/s00423-00019-01762-00425

    Article  PubMed  Google Scholar 

  27. Vandermeeren C, Loi P, Closset J (2017) Does pancreaticogastrostomy decrease the occurrence of delayed gastric emptying after pancreatoduodenectomy? Pancreas. 46:1064–1068. https://doi.org/10.1097/mpa.0000000000000892

    Article  PubMed  Google Scholar 

  28. Jin Y, Feng YY, Qi XG, Hao G, Yu YQ, Li JT, Peng SY (2019) Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: an updated meta-analysis of RCTs and our experience. World J Gastrointest Surg 11:322–332. https://doi.org/10.4240/wjgs.v4211.i4247.4322

    Article  PubMed  PubMed Central  Google Scholar 

  29. Andrianello S, Marchegiani G, Malleo G, Masini G, Balduzzi A, Paiella S, Esposito A, Landoni L, Casetti L, Tuveri M, Salvia R, Bassi C (2020) Pancreaticojejunostomy with externalized stent vs pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3, randomized clinical trial. JAMA Surg 155:1–9. https://doi.org/10.1001/jamasurg.2019.6035

    Article  PubMed Central  Google Scholar 

  30. Benini L, Gabbrielli A, Cristofori C, Amodio A, Butturini G, Cardobi N, Sozzi C, Frulloni L, Mucelli RP, Crinò S, Bassi C, Marchegiani G, Andrianello S, Malleo G, Salvia R (2019) Residual pancreatic function after pancreaticoduodenectomy is better preserved with pancreaticojejunostomy than pancreaticogastrostomy: a long-term analysis. Pancreatology 19:595–601. https://doi.org/10.1016/j.pan.2019.1004.1004

    Article  PubMed  Google Scholar 

  31. Roeyen G, Jansen M, Ruyssinck L, Chapelle T, Vanlander A, Bracke B, Hartman V, Ysebaert D, Berrevoet F (2016) Pancreatic exocrine insufficiency after pancreaticoduodenectomy is more prevalent with pancreaticogastrostomy than with pancreaticojejunostomy. A retrospective multicentre observational cohort study. HPB (Oxford) 18:1017–1022. https://doi.org/10.1016/jhpb201610091002

    Article  Google Scholar 

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Funding

This is a self-funding study.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Hidetoshi Eguchi, Yoshifumi Iwagami, Katsunori Matsushita, Yoshito Tomimaru, Hirofumi Akita, Takehiro Noda, Kunihito Gotoh, Shogo Kobayashi & Yuichiro Doki

  2. Clinical Study Group of Osaka University, Hepato-Biliary-Pancreatic Group, Osaka, Japan

    Hidetoshi Eguchi, Yoshifumi Iwagami, Katsunori Matsushita, Yoshito Tomimaru, Hirofumi Akita, Takehiro Noda, Kunihito Gotoh, Shogo Kobayashi, Hiroaki Nagano, Masaki Mori & Yuichiro Doki

  3. Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan

    Hiroaki Nagano

  4. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Fukuoka, 812-8582, Japan

    Masaki Mori

Authors
  1. Hidetoshi Eguchi
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  2. Yoshifumi Iwagami
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  3. Katsunori Matsushita
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  4. Yoshito Tomimaru
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  5. Hirofumi Akita
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  6. Takehiro Noda
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  7. Kunihito Gotoh
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  8. Shogo Kobayashi
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  9. Hiroaki Nagano
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  10. Masaki Mori
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  11. Yuichiro Doki
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Correspondence to Hidetoshi Eguchi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (#12171) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Eguchi, H., Iwagami, Y., Matsushita, K. et al. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy regarding incidence of delayed gastric emptying after pancreaticoduodenectomy. Langenbecks Arch Surg 405, 921–928 (2020). https://doi.org/10.1007/s00423-020-01982-0

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  • DOI: https://doi.org/10.1007/s00423-020-01982-0

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