The impact of resecting pylorus ring after pancreaticoduodenectomy- the short and long term controlled trial
- VernacularTitle:Нойр булчирхайн толгой тайрах мэс заслын үед ходоодны гарах хэсгийн хавхлагтай хамт тайрах үеийндараах богино ба урт хугацааны үр дүнг проспективэмнэл зүйн санамсаргүй түүвэрлэлт судалгаагаар хянасан нь
- Author:
Manabu Kawai
;
Masaji Tani
;
Seiko Hirono
;
Ken-ichi. Okada
;
Motoki Miyazawa
;
Astusi Shimizu
;
Masaki Ueno
;
Yuji Kitahata
;
Shinya Hayami
;
Syunnsuke Yamaguchi
- Collective Name:Wakayama Medical University, Wakayama
- Publication Type:journal article
- From:Innovation
2014;8(4):118-119
- CountryMongolia
- Language:English
-
Abstract:
Objective:Delayed gastric emptying (DGE) after pylorus-preserving
pancreatoduodenectomy (PpPD) is a persistent and frustrating complication. To
preserve pylorus ring with denervation and devascularization may be a risk factor
of DGE after pancreaticoduodenectomy. We conducted this study to confirm the
hypothesis that pylorus-resecting pancreatoduodenectomy (PrPD) reduces the
incidence of DGE compared to PpPD. Moreover, long-term outcomes of PrPD
and the adverse effect of postsurgical DGE on long-term outcomes have not been
reported. Therefore, in addition, this study focused on long-term outcomes during
24 months after surgery between PrPD versus PpPD.
Methods: Between October 2005 and March 2009, at Wakayama Medical
University Hospital (WMUH), 130 patients with pancreatic or periampullary
lesions were randomized to preservation of the pylorus ring (PpPD) or to resection
of the pylorus ring (PrPD). In PpPD, the proximal duodenum was divided 3-4cm
distal to the pylorus ring. In PrPD, the stomach was divided just adjacent the
pylorus ring and the nearly total stomach more than 95% was preserved. Shortterm
and long-term outcomes were evaluated between PpPD and PrPD. Primary
endpoint is the incidence of DGE. DGE was defined according to a consensus
definition and clinical grading about postoperative DGE proposed by the
international study group of pancreatic surgery (ISGPS). This RCT was registered
at Clinical Trials.Gov NCT00639314.
Results: Of 130 patients who were enrolled in this study, 64 patients were
randomized to PpPD and 66 to PrPD. The overall incidence of DGE in this RCT
was 10.8% (14 of 130 patients); the overall incidence of DGE was significantly
lower in PrPD (4.5%) than PpPD (17.2%) (P =0 .0244). DGE was classified into
three categories proposed by the International Study Group of Pancreatic Surgery.
The proposed clinical grading classified 11 cases of DGE in PpPD into grades A
(n=6), B (n=5), and C (n=0), and one case in PrPD into each of the three grades.
In long-term outcomes, weight loss > grade 2 (Common Terminology Criteria
for Adverse Events, Ver. 4.0) at 24 months after surgery improved significantly
in PrPD (16.2%) compared with PpPD (42.2%) (P = 0.011). Nutritional status
and late postoperative complications were similar between PpPD and PrPD. The
incidence of weight loss greater than Grade 2 at 24 months after surgery was
63.6% in patients with DGE group and 25.3% in patients without DGE group (P
= 0.010). Tmax (the time to peak 13CO2 content in 13C-acetate breath test) at
24 months after surgery in patients with DGE was significantly delayed compared
with those without DGE (27.9 ± 22.7min vs.16.5 ± 10.1min, P=0.023). Serum
albumin at 24 months after surgery was higher in patients without DGE than those
with DGE (3.7±0.6 g/dl vs. 4.1±0.4 g/dl, P=0.013).
Conclusion: This study clarified that PrPD can lead to a significant reduction in
the incidence of DGE compared with PpPD. Moreover, PrPD offers similar longterm
outcomes with PpPD. DGE may be associated with weight loss and poor
nutritional status in long-term outcomes.
