title: Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial.
abstract: OBJECTIVE
  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.
authors.affiliation: *Klinik für Chirurgie, UKSH Campus Lübeck, Lübeck, Germany †Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany ‡Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité - Universitätsmedizin Berlin - Campus Virchow-Klinikum, Berlin, Germany §Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany ¶Klinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Germany ||Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Munich, Germany **Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München und CHIR-Net München, Munich, Germany ††Chirurgische Klinik, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Germany ‡‡Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Marburg, Germany §§Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie des Universitätsklinikums Gießen, Gießen, Germany ¶¶Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Aachen, Aachen, Germany ||||Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Germany ***Abteilung für Allgemeine, Viszerale und Transplantationschirurgie, Universität Heidelberg, Heidelberg, Germany †††Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Barmherzige Brüder, Regensburg, Germany ‡‡‡Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany §§§Institut für Pathologie, Universitätsklinikum Freiburg, Freiburg, Germany ¶¶¶Comprehensive Cancer Center Freiburg, Freiburg Germany ||||||Institut für Medizinische Biometrie und Informatik (IMBI), Universität Heidelberg, Heidelberg, Germany ****Studienzentrum der Deutschen Gesellschaft für Chirurgie
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.forename: U F
authors.initials: UF
authors.lastname: Wellner
authors.forename: M
authors.initials: M
authors.lastname: Bahra
authors.forename: F
authors.initials: F
authors.lastname: Klein
authors.forename: O
authors.initials: O
authors.lastname: Sick
authors.forename: M
authors.initials: M
authors.lastname: Niedergethmann
authors.forename: T J
authors.initials: TJ
authors.lastname: Wilhelm
authors.forename: S A
authors.initials: SA
authors.lastname: Farkas
authors.forename: T
authors.initials: T
authors.lastname: Börner
authors.forename: C
authors.initials: C
authors.lastname: Bruns
authors.forename: A
authors.initials: A
authors.lastname: Kleespies
authors.forename: J
authors.initials: J
authors.lastname: Kleeff
authors.forename: A L
authors.initials: AL
authors.lastname: Mihaljevic
authors.forename: W
authors.initials: W
authors.lastname: Uhl
authors.forename: A
authors.initials: A
authors.lastname: Chromik
authors.forename: V
authors.initials: V
authors.lastname: Fendrich
authors.forename: K
authors.initials: K
authors.lastname: Heeger
authors.forename: W
authors.initials: W
authors.lastname: Padberg
authors.forename: A
authors.initials: A
authors.lastname: Hecker
authors.forename: U P
authors.initials: UP
authors.lastname: Neumann
authors.forename: K
authors.initials: K
authors.lastname: Junge
authors.forename: J C
authors.initials: JC
authors.lastname: Kalff
authors.forename: T R
authors.initials: TR
authors.lastname: Glowka
authors.forename: J
authors.initials: J
authors.lastname: Werner
authors.forename: P
authors.initials: P
authors.lastname: Knebel
authors.forename: P
authors.initials: P
authors.lastname: Piso
authors.forename: M
authors.initials: M
authors.lastname: Mayr
authors.forename: J
authors.initials: J
authors.lastname: Izbicki
authors.forename: Y
authors.initials: Y
authors.lastname: Vashist
authors.forename: P
authors.initials: P
authors.lastname: Bronsert
authors.forename: T
authors.initials: T
authors.lastname: Bruckner
authors.forename: R
authors.initials: R
authors.lastname: Limprecht
authors.forename: M K
authors.initials: MK
authors.lastname: Diener
authors.forename: I
authors.initials: I
authors.lastname: Rossion
authors.forename: I
authors.initials: I
authors.lastname: Wegener
authors.forename: U T
authors.initials: UT
authors.lastname: Hopt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors