Ulla Klaiber1, Pascal Probst1, Felix J Hüttner1, Thomas Bruckner2, Oliver Strobel1, Markus K Diener1, André L Mihaljevic1, Markus W Büchler1, Thilo Hackert3. 1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 2. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany. 3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Thilo.Hackert@med.uni-heidelberg.de.
Abstract
BACKGROUND: The randomized controlled PROPP trial (DKRS00004191) showed that pylorus-resecting pancreatoduodenectomy (PR) is not superior to the pylorus-preserving procedure (PP) in terms of perioperative outcome, specifically in reduction of delayed gastric emptying. Non-superiority of PR was also confirmed in a recent meta-analysis of randomized controlled trials. However, long-term data on morbidity and quality of life after PP compared to PR are sparse. The aim of this study was to investigate long-term outcomes of patients included in the PROPP trial. METHODS:Between February 2013 and June 2016, a total of 188 patients underwent PD and were intraoperatively randomized to either preservation or resection of the pylorus (95 vs. 93 patients). For long-term follow-up, morbidity and quality of life (EORTC QLQ-C30/PAN26) were monitored until January 1, 2018. Statistical analysis was performed on an intention-to-treat basis. RESULTS: The mean duration of follow-up was 34.3 (± 11.3) months. Sixty-three of the 188 patients had died (PP n = 33, PR n = 30), 29 patients were lost to follow-up (PP n = 17, PR n = 12), and the remaining 96 patients were included in long-term follow-up (PP n = 45, PR n = 51). There was no difference between PP and PR patients regarding endocrine and exocrine pancreatic function, receipt of adjuvant/palliative chemotherapy, cancer recurrence, and other relevant characteristics. Late cholangitis occurred significantly more often in patients following pylorus resection (P = 0.042). Reoperations, readmissions to hospital, and quality of life scores except pain were comparable between the two study groups. CONCLUSIONS: Similar to short-term results, long-term follow-up showed no significant differences between pylorus resection compared to pylorus preservation.
RCT Entities:
BACKGROUND: The randomized controlled PROPP trial (DKRS00004191) showed that pylorus-resecting pancreatoduodenectomy (PR) is not superior to the pylorus-preserving procedure (PP) in terms of perioperative outcome, specifically in reduction of delayed gastric emptying. Non-superiority of PR was also confirmed in a recent meta-analysis of randomized controlled trials. However, long-term data on morbidity and quality of life after PP compared to PR are sparse. The aim of this study was to investigate long-term outcomes of patients included in the PROPP trial. METHODS: Between February 2013 and June 2016, a total of 188 patients underwent PD and were intraoperatively randomized to either preservation or resection of the pylorus (95 vs. 93 patients). For long-term follow-up, morbidity and quality of life (EORTC QLQ-C30/PAN26) were monitored until January 1, 2018. Statistical analysis was performed on an intention-to-treat basis. RESULTS: The mean duration of follow-up was 34.3 (± 11.3) months. Sixty-three of the 188 patients had died (PP n = 33, PR n = 30), 29 patients were lost to follow-up (PP n = 17, PR n = 12), and the remaining 96 patients were included in long-term follow-up (PP n = 45, PR n = 51). There was no difference between PP and PR patients regarding endocrine and exocrine pancreatic function, receipt of adjuvant/palliative chemotherapy, cancer recurrence, and other relevant characteristics. Late cholangitis occurred significantly more often in patients following pylorus resection (P = 0.042). Reoperations, readmissions to hospital, and quality of life scores except pain were comparable between the two study groups. CONCLUSIONS: Similar to short-term results, long-term follow-up showed no significant differences between pylorus resection compared to pylorus preservation.
Entities:
Keywords:
Long-term outcomes; Partial pancreatoduodenectomy; Pylorus preservation; Pylorus resection; Quality of life
Authors: James R Butler; Tyrone Rogers; George Eckart; Gregory R Martens; Eugene P Ceppa; Michael G House; Attila Nakeeb; C Max Schmidt; Nicholas J Zyromski Journal: J Gastrointest Surg Date: 2015-02-18 Impact factor: 3.452
Authors: Thilo Hackert; Pascal Probst; Phillip Knebel; Colette Doerr-Harim; Thomas Bruckner; Ulla Klaiber; Jens Werner; Lutz Schneider; Christoph W Michalski; Oliver Strobel; Alexis Ulrich; Markus K Diener; Markus W Büchler Journal: Ann Surg Date: 2018-06 Impact factor: 12.969
Authors: J Busquets; S Martín; Ll Secanella; M Sorribas; N Cornellà; J Altet; N Peláez; M Bajen; T Carnaval; S Videla; J Fabregat Journal: Langenbecks Arch Surg Date: 2022-07-04 Impact factor: 2.895