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Objective: To compare the incidence of delayed gastric emptying (ISGPS 2007 criteria) between patients undergoing retromesenteric versus transmesocolic reconstruction after pancreaticoduodenectomy. Secondary objectives include evaluating overall postoperative morbidity (Clavien-Dindo ≥ Grade I) at 90 days, postoperative pancreatic fistula according to ISGPF criteria, 30- and 90-day mortality, differences in operative time and blood loss, hospital stay duration, exploratory analysis of inflammatory biomarkers in serum and drainage fluid, psychological impact using SCL-90-R scale, and postoperative quality of life using EORTC QLQ-C30 scale.
Methods: Randomized, controlled, single-center superiority clinical trial with 1:1 allocation. One hundred twenty-four patients candidates for duodenopancreatectomy due to pancreatic pathology will be randomized using balanced blocks to transmesocolic (control) or retromesenteric (study) reconstruction. Randomization will be revealed after completing the resection phase. Primary intention-to-treat analysis will estimate relative risk with 95% CI for dichotomous variables, Kaplan-Meier survival analysis with log-rank test, and linear mixed models for repeated measures in quality of life outcomes. Follow-up will be 90 days for the primary endpoint, extending to 12 months for secondary objectives.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Retromesenteric reconstruction | Experimental |
| |
| Transmesocolic reconstruction | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Retromesenteric reconstruction | Procedure | Perform a retromesenteric reconstruction after pancreaticoduodenectomy |
|
| Measure | Description | Time Frame |
|---|---|---|
| Delayed Gastric Emptying | Delayed gastric emptying according to ISGPS 2007 definition: Grade A (nasogastric tube >3 days or reinsertion between days 4-7 + vomiting); Grade B (tube >7 days or reinsertion after day 7 + vomiting); Grade C (impossibility of oral tolerance after day 14) | From first postoperative day to 30 days |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative morbility | Postoperative morbidity at 90 days according to Clavien-Dindo classification (≥ Grade I) | Form first postoperative day to day 30 |
| Pancreatic fistula | Pancreatic fistula according to ISGPF 2016 definition: Grade A (drainage amylase >3x normal on day 3 without clinical impact); Grade B (requiring management change); Grade C (reintervention or death) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Juli Busquets Barenys, Md, PhD | Contact | 93 260 75 00 | jbusquets@bellvitgehospital.cat |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hopital Universitari de Bellvitge | L'Hospitalet de Llobregat | Spain | 08907 | Spain |
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| ID | Term |
|---|---|
| D010190 | Pancreatic Neoplasms |
| D018589 | Gastroparesis |
| ID | Term |
|---|---|
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004701 | Endocrine Gland Neoplasms |
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| Transmesocolic reconstruction | Procedure | Perform the standard reconstruction procedure (transmesocolic) pancreaticoduodenectomy |
|
| From first postoperative day to day 30 |
| Mortality | 30- and 90-day mortality (any cause) | From first postoperative day to day 90 |
| Hospital stay | Postoperative hospital stay days (from surgery to hospital discharge) | From first postoperative day to hospital discharge up to 15 weeks |
| Operative time | Total operative time (minutes) | Periprocedural time, an average time of 300-400 minutes |
| Proportion of patients with NLR index ≥5 | First, a preoperative NLR index determination from the preoperative blood count. Proportion of patients with NLR cut-off point ≥5, which is associated with lower overall survival and recurrence-free survival in patients undergoing pancreatic resection. | From the first postoperative day to one year follow-up |
| Proportion of patients with CA19.9 >37 U/ml | First, a preoperative CA19.9 measurement from preoperative laboratory tests. Determination of the proportion of patients with CA 19.9 cut-off point >37 U/ml, as it is considered elevated according to the standard reference range. | From the first postoperative day to one year follow-up |
| Cytokines in serum |
| From the first postoperative day to day 90 |
| Cytokines in abdominal drainage |
| From the first postoperative day to day 90 |
| Cytokines and complications correlation | Exploratory analysis of the association between cytokine levels and the appearance of complications during the first 90 days. | From the first postoperative day to day 90 |
| Recurrence | - Recurrence of malignant pathology: Defined as the appearance of local, regional, or distant disease documented by imaging techniques (CT/MRI) or histopathological confirmation. | From the first postoperative day to one year follow-up |
| Time to recurrence | - Time to recurrence: Time elapsed from surgery to detection of recurrence (months). | From the first postoperative day to one year follow-up |
| Complications-recurrence correlation | Association analysis between the presence of complications (Clavien-Dindo ≥ II) and early recurrence (≤12 months). | From the first postoperative day to one year follow-up |
| D004066 |
| Digestive System Diseases |
| D010182 | Pancreatic Diseases |
| D004700 | Endocrine System Diseases |
| D013272 | Stomach Diseases |
| D005767 | Gastrointestinal Diseases |
| D010243 | Paralysis |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |