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Hiroki Yamaue - One of the best experts on this subject based on the ideXlab platform.
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Pylorus-Resecting Pancreaticoduodenectomy Offers Long-Term Outcomes Similar to Those of Pylorus-Preserving Pancreaticoduodenectomy: Results of a Prospective Study
World journal of surgery, 2013Co-Authors: Manabu Kawai, Masaji Tani, Seiko Hirono, Ken-ichi Okada, Motoki Miyazawa, Hiroki YamaueAbstract:Background We showed in a previous study that Pylorus-resecting pancreaticoduodenectomy (PrPD), which divides the stomach adjacent to the Pylorus ring, preserves more than 95 % of the stomach and significantly reduced the incidence of delayed gastric emptying (DGE) compared with Pylorus-preserving pancreaticoduodenectomy (PpPD). However, long-term outcomes of PrPD and the adverse effect of early postoperative DGE on long-term outcomes remain unclear.
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Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy a prospective randomized controlled trial of Pylorus resecting versus Pylorus preserving pancreatoduodenectomy
Annals of Surgery, 2011Co-Authors: Manabu Kawai, Masaji Tani, Seiko Hirono, Kazuhisa Uchiyama, Motoki Miyazawa, Atsushi Shimizu, Hiroki YamaueAbstract:Objective:To determine in a prospective randomized controlled trial (RCT) whether Pylorus-resecting pancreatoduodenectomy (PrPD) with preservation of nearly the entire stomach reduces the incidence of delayed gastric emptying (DGE) compared with Pylorus-preserving pancreatoduodenectomy (PpPD).Backgr
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Complications with Reconstruction Procedures in Pylorus-preserving Pancreaticoduodenectomy
World Journal of Surgery, 2005Co-Authors: Masaji Tani, Manabu Kawai, Hiroshi Terasawa, Masaki Ueno, Takashi Hama, Seiko Hirono, Shinomi Ina, Kazuhisa Uchiyama, Hiroki YamaueAbstract:This study was conducted retrospectively to examine the efficacy of Traverso reconstruction compared with Billroth I reconstruction after Pylorus-preserving pancreaticoduodenectomy, in the prevention of several complications. Pylorus-preserving pancreaticoduodenectomy is an aggressive surgery, and insufficiency of the pancreaticoenterostomy plays an important role in the postoperative progression. However, reports examining the correlation between pancreatic fistula and the type of reconstruction after Pylorus-preserving pancreaticoduodenectomy have been limited. Sixty-four patients who underwent Pylorus-preserving pancreaticoduodenectomy (33 reconstructed by the Traverso technique and 31 reconstructed by the Billroth I technique) were entered into this study to investigate whether the complications were related to the type of reconstruction procedure employed. Insufficiency of the pancreaticojejunostomy, including major leakage and pancreatic fistula, occurred in 18.2% of the reconstructions by Billroth I and 0% of the reconstructions by Traverso ( p < 0.05). In addition, jejunal obstruction by recurrent tumor in the remnant pancreas was observed in 3 patients reconstructed by Billroth I, and required palliative bypass surgery. Reconstruction by the Traverso procedure after Pylorus-preserving pancreaticoduodenectomy is a safe surgical method and has an advantage for advanced pancreatic cancer, which has high risk of jejunal obstruction by recurrent tumor in the remnant pancreas.
Ulla Klaiber - One of the best experts on this subject based on the ideXlab platform.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of Gastrointestinal Surgery, 2020Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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. 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. 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. Similar to short-term results, long-term follow-up showed no significant differences between Pylorus resection compared to Pylorus preservation.
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meta analysis of delayed gastric emptying after Pylorus preserving versus Pylorus resecting pancreatoduodenectomy
British Journal of Surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Markus K. Diener, Markus W. Büchler, Colette Dorrharim, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Meta‐analysis of delayed gastric emptying after Pylorus‐preserving versus Pylorus‐resecting pancreatoduodenectomy
The British journal of surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Colette Dörr-harim, Markus K. Diener, Markus W. Büchler, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Pylorus preservation pancreatectomy or not
Translational gastroenterology and hepatology, 2017Co-Authors: Ulla Klaiber, Pascal Probst, Markus W. Büchler, Thilo HackertAbstract:Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without Pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons. After its oncological adequacy was questioned initially, Pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the Pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the Pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, Pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the Pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that Pylorus resection does not reduce DGE compared to the Pylorus-preserving operation. Non-superiority of Pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without Pylorus preservation and derives recommendations for daily practice.
Markus K. Diener - One of the best experts on this subject based on the ideXlab platform.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of Gastrointestinal Surgery, 2020Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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. 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. 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. Similar to short-term results, long-term follow-up showed no significant differences between Pylorus resection compared to Pylorus preservation.
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meta analysis of delayed gastric emptying after Pylorus preserving versus Pylorus resecting pancreatoduodenectomy
British Journal of Surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Markus K. Diener, Markus W. Büchler, Colette Dorrharim, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Meta‐analysis of delayed gastric emptying after Pylorus‐preserving versus Pylorus‐resecting pancreatoduodenectomy
The British journal of surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Colette Dörr-harim, Markus K. Diener, Markus W. Büchler, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Pylorus resection or Pylorus preservation in partial pancreatico-duodenectomy (PROPP study): study protocol for a randomized controlled trial.
Trials, 2013Co-Authors: Thilo Hackert, Oliver Strobel, Colette Dörr-harim, Markus K. Diener, Phillip Knebel, Thomas Bruckner, Lutz Schneider, Werner Hartwig, Stefan Fritz, Jens WernerAbstract:Partial pancreatico-duodenectomy (PD) is the standard treatment for tumors of the pancreatic head. Today, preservation of the Pylorus has been widely accepted as the surgical standard in this procedure. A common postoperative complication is the occurrence of delayed gastric emptying (DGE), which causes impairment of oral intake andpatients’ quality of life, prolongation of hospital stay and delay of further treatment (for example adjuvant chemotherapy). In a small number of two retrospective and one randomized studies, a modification by resection of the Pylorus with preservation of the stomach has shown to reduce DGE incidence. The aim of the present study is to investigate the effect of Pylorus resection on postoperative DGE in PD. Patients undergoing elective PD for any indication equal or older than 18 years and who have given informed consent will be included. Patients will be randomized to either PD with Pylorus preservation or PD with Pylorus resection and complete stomach preservation. Sample size (n = 89 patients per group) is calculated on an assumed difference in DGE incidence of 20%. Primary study endpoint is DGE within 30 days; secondary endpoints are operation time, blood loss, morbidity, mortality, hospital stay and quality of life (QoL). DGE is a relevant clinical problem following PD with a great impact on patients’ recovery, length of hospital stay, QoL and consecutive adjuvant therapies. As there is no causal therapy, prevention of DGE is essential to improve outcome. The technical modification of Pylorus resection may offer a simple and effective method for this purpose. The present study is designed to increase the existing body of evidence and potentially change the future standard surgical procedure of PD. German Clinical Trials Register DRKS00004191.
Markus W. Büchler - One of the best experts on this subject based on the ideXlab platform.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of Gastrointestinal Surgery, 2020Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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. 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. 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. Similar to short-term results, long-term follow-up showed no significant differences between Pylorus resection compared to Pylorus preservation.
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meta analysis of delayed gastric emptying after Pylorus preserving versus Pylorus resecting pancreatoduodenectomy
British Journal of Surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Markus K. Diener, Markus W. Büchler, Colette Dorrharim, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Meta‐analysis of delayed gastric emptying after Pylorus‐preserving versus Pylorus‐resecting pancreatoduodenectomy
The British journal of surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Colette Dörr-harim, Markus K. Diener, Markus W. Büchler, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Pylorus preservation pancreatectomy or not
Translational gastroenterology and hepatology, 2017Co-Authors: Ulla Klaiber, Pascal Probst, Markus W. Büchler, Thilo HackertAbstract:Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without Pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons. After its oncological adequacy was questioned initially, Pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the Pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the Pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, Pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the Pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that Pylorus resection does not reduce DGE compared to the Pylorus-preserving operation. Non-superiority of Pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without Pylorus preservation and derives recommendations for daily practice.
Pascal Probst - One of the best experts on this subject based on the ideXlab platform.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of Gastrointestinal Surgery, 2020Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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.
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Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Markus K. Diener, Markus W. Büchler, Thomas Bruckner, Felix J. Hüttner, André L. Mihaljevic, Thilo HackertAbstract: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. 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. 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. Similar to short-term results, long-term follow-up showed no significant differences between Pylorus resection compared to Pylorus preservation.
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meta analysis of delayed gastric emptying after Pylorus preserving versus Pylorus resecting pancreatoduodenectomy
British Journal of Surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Markus K. Diener, Markus W. Büchler, Colette Dorrharim, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Meta‐analysis of delayed gastric emptying after Pylorus‐preserving versus Pylorus‐resecting pancreatoduodenectomy
The British journal of surgery, 2018Co-Authors: Ulla Klaiber, Pascal Probst, Oliver Strobel, Christoph W. Michalski, Colette Dörr-harim, Markus K. Diener, Markus W. Büchler, T. HackertAbstract:Background Delayed gastric emptying (DGE) is a frequent complication after Pylorus-preserving pancreatoduodenectomy. Recent studies have suggested that resection of the Pylorus is associated with decreased rates of DGE. However, superiority of Pylorus-resecting pancreatoduodenectomy was not shown in a recent RCT. This meta-analysis summarized evidence of the effectiveness and safety of Pylorus-preserving compared with Pylorus-resecting pancreatoduodenectomy. Methods RCTs and non-randomized studies comparing outcomes of Pylorus-preserving and Pylorus-resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random-effects meta-analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non-randomized studies. Results Three RCTs and eight non-randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for Pylorus-resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. -1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion Pylorus-resecting pancreatoduodenectomy is not superior to Pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.
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Pylorus preservation pancreatectomy or not
Translational gastroenterology and hepatology, 2017Co-Authors: Ulla Klaiber, Pascal Probst, Markus W. Büchler, Thilo HackertAbstract:Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without Pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons. After its oncological adequacy was questioned initially, Pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the Pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the Pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, Pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the Pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that Pylorus resection does not reduce DGE compared to the Pylorus-preserving operation. Non-superiority of Pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without Pylorus preservation and derives recommendations for daily practice.
