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Novel Technique for Single-Layer Pancreatojejunostomy is Not Inferior to Modified Blumgart Anastomosis in Robotic Pancreatoduodenectomy: Results of a Randomized Controlled Trial

  • Pancreatic Tumors
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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 ≤ 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 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.org.cn).

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Acknowledgment

The authors thank Dr. Peng Ding [anesthesiologist, Department of Anesthesiology, Chinese People’s Liberation Army (PLA) no. 983 Hospital, Tianjing, China] for his assistance with the figures.

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Author notes

  1. Qu Liu and Zhiming Zhao contributed equally to this work, and both should be considered first author.

Authors and Affiliations

  1. Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China

    Qu Liu MD, Zhiming Zhao MD, Yuanxing Gao MD, Guodong Zhao MD, Nan Jiang MD & Rong Liu MD

  2. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China

    Wan Yee Lau MD, FRCS, FRACS Hon

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  1. Qu Liu MD
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Liu, Q., Zhao, Z., Gao, Y. et al. Novel Technique for Single-Layer Pancreatojejunostomy is Not Inferior to Modified Blumgart Anastomosis in Robotic Pancreatoduodenectomy: Results of a Randomized Controlled Trial. Ann Surg Oncol 28, 2346–2355 (2021). https://doi.org/10.1245/s10434-020-09204-z

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