• Annals of surgery · Jun 2018

    Randomized Controlled Trial

    Pylorus Resection Does Not Reduce Delayed Gastric Emptying After Partial Pancreatoduodenectomy: A Blinded Randomized Controlled Trial (PROPP Study, DRKS00004191).

    • 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, and Markus W Büchler.
    • Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
    • Ann. Surg. 2018 Jun 1; 267 (6): 1021-1027.

    ObjectivesThe aim of this study was to investigate the effect of pylorus resection on postoperative delayed gastric emptying (DGE) after partial pancreatoduodenectomy (PD).BackgroundPD is the standard treatment for tumors of the pancreatic head. Preservation of the pylorus has been widely accepted as standard procedure. DGE is a common complication causing impaired oral intake, prolonged hospital stay, and postponed further treatment. Recently, pylorus resection has been shown to reduce DGE.MethodsPatients undergoing PD for any indication at the University of Heidelberg were randomized to either PD with pylorus preservation (PP) or PD with pylorus resection and complete stomach preservation (PR). The primary endpoint was DGE within 30 days according to the International Study Group of Pancreatic Surgery definition.ResultsNinety-five patients were randomized to PP and 93 patients to PR. There were no baseline imbalances between the groups. Overall, 53 of 188 patients (28.2%) developed a DGE (grade: A 15.5%; B 8.8%; C 3.3%). In the PP group 24 of 95 patients (25.3%) and in the PR group 29 of 93 patients (31.2%) developed DGE (odds ratio 1.534, 95% confidence interval 0.788 to 2.987; P = 0.208). Higher BMI, indigestion, and intraabdominal major complications were significant risk factors for DGE.ConclusionsIn this randomized controlled trial, pylorus resection during PD did not reduce the incidence or severity of DGE. The development of DGE seems to be multifactorial rather than attributable to pyloric dysfunction alone. Pylorus preservation should therefore remain the standard of care in PD.Trial RegistrationGerman Clinical Trials Register DRKS00004191.

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