Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy

Background: Pancreaticoduodenectomy (PD) is associated with a high incidence of postoperative complications including pancreatic fistula. This randomized clinical trial compared the incidence of pancreatic fistula between the isolated Roux-en-Y (IsoRY) and conventional reconstruction (CR) methods. Methods: Patients admitted for PD between June 2009 and September 2012 in a single centre were assigned randomly to CR or IsoRY. The primary endpoint was the incidence of pancreatic fistula (grade A-C) defined according to the International Study Group on Pancreatic Fistula. Secondary endpoints were complication rates, mortality and hospital stay. Multiple logistic regression analysis was performed to identify factors associated with pancreatic fistula. Results: Some 153 patients were randomized, 76 to CR and 77 to IsoRY; two patients from the IsoRY group were excluded after randomization. Pancreatic fistula occurred in 26 patients (34 per cent) in the CR group and 25 (33 per cent) in the IsoRY group (P = 0.909). The number of patients with a clinically relevant pancreatic fistula (grade B or C) was similar in the two groups (10 and 11 patients respectively; P = 0.789), as were complication rates (42 versus 40 per cent; P = 0.793) and mortality (none in either group; P = 0.999). Soft pancreas was the only independent risk factor for pancreatic fistula (odds ratio 4.42, 95 per cent confidence interval 1 85 to 10 53; P < 0.001). Conclusion: This study showed that IsoRY reconstruction does not reduce the incidence of pancreatic fistula compared with CR.