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Publications

Journal Article Ahead of print

PubMed: 42832388 DOI: 10.1097/SLA.0000000000007182

Impact of Side-to-Side Versus End-to-Side Gastrojejunostomy on the Rate of Delayed Gastric Emptying After Pancreatoduodenectomy (IPAD study): A Randomized Controlled Trial.

Ann Surg

Authors: Fabien Robin, Edouard Wasielewski, Mohamed A Chaouch, Chloé Rousseau, Anaïs Palen, Raffaele V De Rosa, Jacques Ewald, Alessia Fassari, Aude Merdrignac, Marie Livin, Yolene Pages, Bruno Laviolle, Olivier Turrini, Jonathan Garnier, Laurent Sulpice

Affiliations

  • Hepatobiliary and Digestive Surgery Department, University Hospital of Rennes, France.
  • CHU Rennes, Univ Rennes, Inserm, UMR_S 1085 (IRSET), CIC 1414, Rennes, France.
  • Oncogenesis Stress Signalling (OSS), Inserm U1242, OSS, University Hospital of Rennes, France.
  • Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
  • Direction of Clinical Research, Institut Paoli-Calmettes, Marseille, France.
  • Aix-Marseille University, Marseille, France.

Abstract

OBJECTIVE

To evaluate whether side-to-side gastrojejunostomy (SSGJ) reduces delayed gastric emptying (DGE) compared with end-to-side gastrojejunostomy (ESGJ) after pancreatoduodenectomy (PD).

SUMMARY BACKGROUND DATA

DGE is one of the most frequent complications after PD, leading to prolonged recovery and increased morbidity. Retrospective studies have suggested that the configuration of the gastrojejunostomy may influence DGE, but no randomized trial has confirmed this.

METHODS

The IPAD study was a prospective, randomized, open-label trial conducted at 2 high-volume pancreatic centers in France. Adult patients undergoing PD for benign or malignant disease were randomized intraoperatively (1:1) to SSGJ or ESGJ and followed for 90 days. The primary endpoint was the incidence of DGE. Secondary endpoints included postoperative complications, nutritional outcomes, and quality of life (QoL) assessed at 90 days using the GastroIntestinal Quality of Life Index (GIQLI).

RESULTS

From May 1, 2021 to July 1, 2023, among 171 screened patients, 158 were randomized (79 per group). Baseline characteristics were comparable except for sex distribution and rates of hypertension and chronic obstructive pulmonary disease. DGE occurred in 38.0% of patients after SSGJ and 30.4% after ESGJ (risk ratio 1.25; 95% CI: 0.81-1.94; P=0.314). Rates of pancreatic fistula, biliary fistula, reintervention, and mortality were similar. At 90 days, nutritional parameters and GIQLI scores (87.9 vs. 86.6; P=0.68) did not differ between groups.

CONCLUSIONS

The present RCT found no significant difference in the rate of DGE between SSGJ and ESGJ. Postoperative outcomes, nutritional status, and quality of life were comparable, indicating that both techniques yielded comparable outcomes.

MeSH

Quality Of Life, Fistula, Pancreaticoduodenectomy, Gastric Emptying, General Surgery, Biliary Fistula