Novel Technique for Single-Layer Pancreatojejunostomy is Not Inferior to Modified Blumgart Anastomosis in Robotic Pancre
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Novel Technique for Single-Layer Pancreatojejunostomy is Not Inferior to Modified Blumgart Anastomosis in Robotic Pancreatoduodenectomy: Results of a Randomized Controlled Trial Qu Liu, MD1, Zhiming Zhao, MD1, Yuanxing Gao, MD1, Guodong Zhao, MD1, Nan Jiang, MD1, Wan Yee Lau, MD, FRCS, FRACS Hon2, and Rong Liu, MD1 1
Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China; 2Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
ABSTRACT Background. A novel technique of single-layer continuous suturing (SCS) for pancreaticojejunostomy (PJ) during robotic pancreaticoduodenectomy (RPD), a technically straightforward procedure, has been shown to produce promising results in a previous study. The present RCT aims to show that SCS during RPD does not increase the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) when compared with modified Blumgart anastomosis (MBA). Patients and Methods. Between January 2019 and September 2019, consecutive patients (ASA score B 2) who underwent RPD were enrolled and randomized to the SCS or the MBA group. The primary endpoint was the rate of CR-POPF. A noninferiority margin of 10% was chosen. Results. Of the 186 patients, 4 were excluded because PJ was not performed. The remaining 182 patients were randomized to the SCS group (n = 89) or MBA group (n = 93). CR-POPF rate was not inferior in the SCS group [SCS: 6.7%, MBA: 11.8%; 95% confidence interval (- 0.76, - 0.06), P = 0.0002]. PJ duration was
Qu Liu and Zhiming Zhao contributed equally to this work, and both should be considered first author. Ó Society of Surgical Oncology 2020 First Received: 18 May 2020 Accepted: 20 September 2020 R. Liu, MD e-mail: [email protected]
significantly lower in the SCS group (P \ 0.01). No significant differences were found between the two groups in operative time, estimated blood loss, postoperative hospital stay, or rates of conversion to laparotomy, morbidity, reoperation, or mortality. On subgroup analysis of patients with a soft pancreas and small main pancreatic duct, SCS significantly reduced the duration of PJ. Conclusions. This study showed that SCS was not inferior to MBA in terms of the CR-POPF rate during RPD. Registration number: ChiCTR1800020086 (www.Chictr.o rg.cn).
Pancreaticoduodenectomy (PD) is a technically very challenging abdominal operation. Previous studies have shown that its postoperative morbidity and mortality rates, which were significantly related to the volume of a surgical center, ranged from 31.8% to 41.0% and 1.0% to 2.8%, respectively.1–4 Recent developments in robotic surgery, which has overcome the limitations of laparoscopic surgery, have led to the gradual acceptance of robotic technology in pancreatic surgery.5,6 Since Giulianotti first reported robotic pancreaticoduodenectomy (RPD) in 2003,7 numerous studies have demonstrated that RPD is safe and feasible in w
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