Hirochika Toyama1, Ippei Matsumoto2, Takuya Mizumoto1, Hirofumi Fujita3, Shinobu Tsuchida4, Yoshihiro Kanbara5, Yoshihiko Kadowaki6, Hiromi Maeda7, Keiichi Okano8, Masato Fukuoka9, Shiro Takase10, Sachiyo Shirakawa1, Sachio Terai1, Hideyo Mukubo1, Jun Ishida1, Hironori Yamashita1, Kimihiko Ueno1, Motofumi Tanaka1, Masahiro Kido1, Tetsuo Ajiki1, Sae Murakami11, Kunihiro Nishimura12, Takumi Fukumoto1. 1. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan. 2. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan. 3. Department of Surgery, Seirei Mikatahara General Hospital, Shizuoka, Japan. 4. Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan. 5. Department of Surgery, Saiseikai Suita Hospital, Osaka, Japan. 6. Department of Surgery, Japan Red Cross Kobe Hospital, Hyogo, Japan. 7. Department of Surgery, Kobe Rosai Hospital, Hyogo, Japan. 8. Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan. 9. Department of Surgery, Steel Memorial Hirohata Hospital, Hyogo, Japan. 10. Department of Surgery, Hyogo Prefectural Kakogawa Medical Center, Hyogo, Japan. 11. Clinical Translational Research Center of Kobe University Hospital, Hyogo, Japan. 12. Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Abstract
OBJECTIVE: This study aimed to determine whether retrocolic alimentary tract reconstruction is noninferior to antecolic reconstruction in terms of DGE incidence after pancreatoduodenectomy (PD) and investigated patients' postoperative nutritional status. SUMMARY OF BACKGROUND DATA: The influence of the route of alimentary tract reconstruction on DGE after PD is controversial. METHODS: Patients from 9 participating institutions scheduled for PD were randomly allocated to the retrocolic or antecolic reconstruction groups. The primary outcome was incidence of DGE, defined according to the 2007 version of the International Study Group for Pancreatic Surgery definition. Noninferiority would be indicated if the incidence of DGE in the retrocolic group did not exceed that in the antecolic group by a margin of 10%. Patients' postoperative nutrition data were compared as secondary outcomes. RESULTS: Total, 109 and 103 patients were allocated to the retrocolic and antecolic reconstruction group, respectively (n = 212). Baseline characteristics were similar between both groups. DGE occurred in 17 (15.6%) and 13 (12.6%) patients in the retrocolic and antecolic group, respectively (risk difference; 2.97%, 95% confidence interval; -6.3% to 12.6%, which exceeded the specified margin of 10%). There were no differences in the incidence of other postoperative complications and in the duration of hospitalization. Postoperative nutritional indices were similar between both groups. CONCLUSIONS: This trial could not demonstrate the noninferiority of retrocolic to antecolic alimentary tract reconstruction in terms of DGE incidence. The alimentary tract should not be reconstructed via the retrocolic route after PD, to prevent DGE.
OBJECTIVE: This study aimed to determine whether retrocolic alimentary tract reconstruction is noninferior to antecolic reconstruction in terms of DGE incidence after pancreatoduodenectomy (PD) and investigated patients' postoperative nutritional status. SUMMARY OF BACKGROUND DATA: The influence of the route of alimentary tract reconstruction on DGE after PD is controversial. METHODS: Patients from 9 participating institutions scheduled for PD were randomly allocated to the retrocolic or antecolic reconstruction groups. The primary outcome was incidence of DGE, defined according to the 2007 version of the International Study Group for Pancreatic Surgery definition. Noninferiority would be indicated if the incidence of DGE in the retrocolic group did not exceed that in the antecolic group by a margin of 10%. Patients' postoperative nutrition data were compared as secondary outcomes. RESULTS: Total, 109 and 103 patients were allocated to the retrocolic and antecolic reconstruction group, respectively (n = 212). Baseline characteristics were similar between both groups. DGE occurred in 17 (15.6%) and 13 (12.6%) patients in the retrocolic and antecolic group, respectively (risk difference; 2.97%, 95% confidence interval; -6.3% to 12.6%, which exceeded the specified margin of 10%). There were no differences in the incidence of other postoperative complications and in the duration of hospitalization. Postoperative nutritional indices were similar between both groups. CONCLUSIONS: This trial could not demonstrate the noninferiority of retrocolic to antecolic alimentary tract reconstruction in terms of DGE incidence. The alimentary tract should not be reconstructed via the retrocolic route after PD, to prevent DGE.
Authors: Felix J Hüttner; Rosa Klotz; Alexis Ulrich; Markus W Büchler; Pascal Probst; Markus K Diener Journal: Cochrane Database Syst Rev Date: 2022-01-11