A national, multicenter, randomized, prospective, parallel group clinical study to evaluate two therapeutic strategies (invaginating pancreatogastric anastomosis versus Blumgart anastomosis).

Background: Postoperative pancreatic fistula is currently the most frequent complications after duodenopancreatectomy. There are currently no RCT comparing two of the most frequently used method of pancreato-enteric anastomosis (invaginating pancreatogastric anastomosis versus Blumgart anastomosis)

Hypothesis: in patients with resectable pancreatic and periampullary tumors, performing a Blumgart (AB) anastomosis for pancreatoenteric reconstruction after duodenopancreatectomy decreases the rate of postoperative pancreatic fistula (PPF) compared to to pancreatogastric anastomosis.

Main goal: To comparatively evaluate the rate of PPF in patients with pancreatic and periampullary tumors undergoing cephalic duodenopancreatectomy after reconstruction with Blumgart anastomosis or pancreatogastric anastomosis.

Inclusion Criteria:

• Patients over 18 years old.
• Diagnosis of pancreatic and periampullary tumor pathology that requires pancreatoduodenectomy
• Signature of informed consent by the patient or his legal representative

Exclusion Criteria:

• Patients in whom liver metastases or peritoneal carcinomatosis are detected during surgery.
• Patients in whom tumor resection is ultimately not achieved due to intraoperative evidence that the tumor is locally advanced, unresectable.
• Patients with macroscopic residual tumor (R2).
• High risk patients with severe pathology (ASA IV) according to the American Association of Anesthetists.