Perioperative management in distal pancreatectomy: Results of a survey in 23 European participating centres of the DISPACT trial and a review of literature

Helge Bruns; Nuh N. Rahbari; Thorsten Löffler; Markus K. Diener; Christoph M. Seiler; Matthias Glanemann; Giovanni Butturini; Christoph Schuhmacher; Inga Rossion; Markus W. Büchler; Tido Junghans; D. Gouma; N. van der Gaag; J. Müller; T. Junghans; P. Neuhaus; M. Glanemann; K. Gellert; F. Fritze; W. Uhl; O. Belyaev; H. Witzigmann; H. Lauer; U. T. Hopt; T. Keck; X. Rogiers; F. Berrevoet; W. Büchler; N. Rahbari; M. Schilling; J. Schuld; T. Beckurts; E. Pfisterer; M. Heiss; C. Rudroff; J. P. Neoptolemos; M. Raraty; S. Repse; A. Tomazic; H. W. Bruch; U. Roblick; S. Post; N. Aramin; M. Rothmund; D. Bartsch; K. W. Jauch; C. Bruns; R. Siewert; H. Friess; H. J. Schlitt; J. Werner; C. Bassi; A. Thiede; C. T. Germer; U. Steger; H. Zirngibl; S. Ganzera

doi:10.1186/1745-6215-10-58

Perioperative management in distal pancreatectomy: Results of a survey in 23 European participating centres of the DISPACT trial and a review of literature

Helge Bruns
, Nuh N. Rahbari
, Thorsten Löffler
, Markus K. Diener
, Christoph M. Seiler
, Matthias Glanemann
, Giovanni Butturini
, Christoph Schuhmacher
, Inga Rossion
, Markus W. Büchler
, Tido Junghans
, D. Gouma
, N. van der Gaag
, J. Müller
, T. Junghans
, P. Neuhaus
, M. Glanemann
, K. Gellert
, F. Fritze
, W. Uhl

O. Belyaev, H. Witzigmann, H. Lauer, U. T. Hopt, T. Keck, X. Rogiers, F. Berrevoet, W. Büchler, N. Rahbari, M. Schilling, J. Schuld, T. Beckurts, E. Pfisterer, M. Heiss, C. Rudroff, J. P. Neoptolemos, M. Raraty, S. Repse, A. Tomazic, H. W. Bruch, U. Roblick, S. Post, N. Aramin, M. Rothmund, D. Bartsch, K. W. Jauch, C. Bruns, R. Siewert, H. Friess, H. J. Schlitt, J. Werner, C. Bassi, A. Thiede, C. T. Germer, U. Steger, H. Zirngibl, S. Ganzera

Medicine and Health

Heidelberg University
Charité – Universitätsmedizin Berlin
University of Verona
Technical University of Munich
Amsterdam University Medical Centers
Sana
Huntington-Zentrum (NRW) Bochum im St. Josef Hospital
Municipal Clinical Centre
University of Freiburg
University Medical Centre
University Hospital Heidelberg
Saarland University Medical Center
Augustins gGmbH
Krankenhaus Merheim
The Royal Liverpool University Hospital
University Medical Centre Ljubljana
Universitätsklinikum Schleswig-Holstein Campus Lübeck
University of Mannheim
Philipps-Universität Marburg
University of Munich
Klinikum der Universität Regensburg und Medizinische Fakultät
University of Würzburg
Helios Klinikum Wuppertal

Research output: Contribution to journal › Review article › peer-review

23 Scopus citations

Abstract

Background: Concomitant treatment in addition to intervention may influence the primary outcome, especially in complex interventions such as surgical trials. Evidence-based standards for perioperative care after distal pancreatectomy, however, have been rarely defined. This study's objective was therefore to identify and analyse the current basis of evidence for perioperative management in distal pancreatectomy. Methods: A standardised questionnaire was sent to 23 European centres recruiting patients for a randomized controlled trial (RCT) on open distal pancreatectomy that would compare suture versus stapler closure of the pancreatic remnant (DISPACT trial, ISRCTN 18452029). Perioperative strategies (e.g., bowel preparation, pain management, administration of antibiotics, abdominal incision, drainages, nasogastric tubes, somatostatin, mobilisation and feeding regimens) were assessed. Moreover, a systematic literature search in the Medline database was performed and retrieved meta-analyses and RCTs were reviewed. Results: All 23 centres returned the questionnaire. Consensus for thoracic epidural catheters (TECs), pain treatment and transverse incisions was found, as well as strong consensus for the placement of intra-abdominal drainages and perioperative single-shot antibiotics. Also, there was consensus that bowel preparation, somatostatin application, postoperative nasogastric tubes and intravenous feeding might not be beneficial. The literature search identified 16 meta-analyses and 19 RCTs demonstrating that bowel preparation, somatostatin therapy and nasogastric tubes can be omitted. Early mobilisation, feeding and TECs seem to be beneficial for patients. The value of drainages remains unclear. Conclusion: Most perioperative standards within the centres participating in the DISPACT trial are in accordance with current available evidence. The need for drainages requires further investigation.

Original language	English
Article number	58
Journal	Trials
Volume	10
DOIs	https://doi.org/10.1186/1745-6215-10-58
State	Published - 1 Jan 2009

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Bruns, H., Rahbari, N. N., Löffler, T., Diener, M. K., Seiler, C. M., Glanemann, M., Butturini, G., Schuhmacher, C., Rossion, I., Büchler, M. W., Junghans, T., Gouma, D., van der Gaag, N., Müller, J., Junghans, T., Neuhaus, P., Glanemann, M., Gellert, K., Fritze, F., ... Ganzera, S. (2009). Perioperative management in distal pancreatectomy: Results of a survey in 23 European participating centres of the DISPACT trial and a review of literature. Trials, 10, Article 58. https://doi.org/10.1186/1745-6215-10-58

@article{10d7acfd2c7a49baad052bf24b69080d,

title = "Perioperative management in distal pancreatectomy: Results of a survey in 23 European participating centres of the DISPACT trial and a review of literature",

abstract = "Background: Concomitant treatment in addition to intervention may influence the primary outcome, especially in complex interventions such as surgical trials. Evidence-based standards for perioperative care after distal pancreatectomy, however, have been rarely defined. This study's objective was therefore to identify and analyse the current basis of evidence for perioperative management in distal pancreatectomy. Methods: A standardised questionnaire was sent to 23 European centres recruiting patients for a randomized controlled trial (RCT) on open distal pancreatectomy that would compare suture versus stapler closure of the pancreatic remnant (DISPACT trial, ISRCTN 18452029). Perioperative strategies (e.g., bowel preparation, pain management, administration of antibiotics, abdominal incision, drainages, nasogastric tubes, somatostatin, mobilisation and feeding regimens) were assessed. Moreover, a systematic literature search in the Medline database was performed and retrieved meta-analyses and RCTs were reviewed. Results: All 23 centres returned the questionnaire. Consensus for thoracic epidural catheters (TECs), pain treatment and transverse incisions was found, as well as strong consensus for the placement of intra-abdominal drainages and perioperative single-shot antibiotics. Also, there was consensus that bowel preparation, somatostatin application, postoperative nasogastric tubes and intravenous feeding might not be beneficial. The literature search identified 16 meta-analyses and 19 RCTs demonstrating that bowel preparation, somatostatin therapy and nasogastric tubes can be omitted. Early mobilisation, feeding and TECs seem to be beneficial for patients. The value of drainages remains unclear. Conclusion: Most perioperative standards within the centres participating in the DISPACT trial are in accordance with current available evidence. The need for drainages requires further investigation.",

author = "Helge Bruns and Rahbari, \{Nuh N.\} and Thorsten L{\"o}ffler and Diener, \{Markus K.\} and Seiler, \{Christoph M.\} and Matthias Glanemann and Giovanni Butturini and Christoph Schuhmacher and Inga Rossion and B{\"u}chler, \{Markus W.\} and Tido Junghans and D. Gouma and \{van der Gaag\}, N. and J. M{\"u}ller and T. Junghans and P. Neuhaus and M. Glanemann and K. Gellert and F. Fritze and W. Uhl and O. Belyaev and H. Witzigmann and H. Lauer and Hopt, \{U. T.\} and T. Keck and X. Rogiers and F. Berrevoet and W. B{\"u}chler and N. Rahbari and M. Schilling and J. Schuld and T. Beckurts and E. Pfisterer and M. Heiss and C. Rudroff and Neoptolemos, \{J. P.\} and M. Raraty and S. Repse and A. Tomazic and Bruch, \{H. W.\} and U. Roblick and S. Post and N. Aramin and M. Rothmund and D. Bartsch and Jauch, \{K. W.\} and C. Bruns and R. Siewert and H. Friess and Schlitt, \{H. J.\} and J. Werner and C. Bassi and A. Thiede and Germer, \{C. T.\} and U. Steger and H. Zirngibl and S. Ganzera",

year = "2009",

month = jan,

day = "1",

doi = "10.1186/1745-6215-10-58",

language = "English",

volume = "10",

journal = "Trials",

issn = "1745-6215",

publisher = "BioMed Central Ltd.",

}

Bruns, H, Rahbari, NN, Löffler, T, Diener, MK, Seiler, CM, Glanemann, M, Butturini, G, Schuhmacher, C, Rossion, I, Büchler, MW, Junghans, T, Gouma, D, van der Gaag, N, Müller, J, Junghans, T, Neuhaus, P, Glanemann, M, Gellert, K, Fritze, F, Uhl, W, Belyaev, O, Witzigmann, H, Lauer, H, Hopt, UT, Keck, T, Rogiers, X, Berrevoet, F, Büchler, W, Rahbari, N, Schilling, M, Schuld, J, Beckurts, T, Pfisterer, E, Heiss, M, Rudroff, C, Neoptolemos, JP, Raraty, M, Repse, S, Tomazic, A, Bruch, HW, Roblick, U, Post, S, Aramin, N, Rothmund, M, Bartsch, D, Jauch, KW, Bruns, C, Siewert, R, Friess, H, Schlitt, HJ, Werner, J, Bassi, C, Thiede, A, Germer, CT, Steger, U, Zirngibl, H & Ganzera, S 2009, 'Perioperative management in distal pancreatectomy: Results of a survey in 23 European participating centres of the DISPACT trial and a review of literature', Trials, vol. 10, 58. https://doi.org/10.1186/1745-6215-10-58

TY - JOUR

T1 - Perioperative management in distal pancreatectomy

T2 - Results of a survey in 23 European participating centres of the DISPACT trial and a review of literature

AU - Bruns, Helge

AU - Rahbari, Nuh N.

AU - Löffler, Thorsten

AU - Diener, Markus K.

AU - Seiler, Christoph M.

AU - Glanemann, Matthias

AU - Butturini, Giovanni

AU - Schuhmacher, Christoph

AU - Rossion, Inga

AU - Büchler, Markus W.

AU - Junghans, Tido

AU - Gouma, D.

AU - van der Gaag, N.

AU - Müller, J.

AU - Junghans, T.

AU - Neuhaus, P.

AU - Glanemann, M.

AU - Gellert, K.

AU - Fritze, F.

AU - Uhl, W.

AU - Belyaev, O.

AU - Witzigmann, H.

AU - Lauer, H.

AU - Hopt, U. T.

AU - Keck, T.

AU - Rogiers, X.

AU - Berrevoet, F.

AU - Büchler, W.

AU - Rahbari, N.

AU - Schilling, M.

AU - Schuld, J.

AU - Beckurts, T.

AU - Pfisterer, E.

AU - Heiss, M.

AU - Rudroff, C.

AU - Neoptolemos, J. P.

AU - Raraty, M.

AU - Repse, S.

AU - Tomazic, A.

AU - Bruch, H. W.

AU - Roblick, U.

AU - Post, S.

AU - Aramin, N.

AU - Rothmund, M.

AU - Bartsch, D.

AU - Jauch, K. W.

AU - Bruns, C.

AU - Siewert, R.

AU - Friess, H.

AU - Schlitt, H. J.

AU - Werner, J.

AU - Bassi, C.

AU - Thiede, A.

AU - Germer, C. T.

AU - Steger, U.

AU - Zirngibl, H.

AU - Ganzera, S.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background: Concomitant treatment in addition to intervention may influence the primary outcome, especially in complex interventions such as surgical trials. Evidence-based standards for perioperative care after distal pancreatectomy, however, have been rarely defined. This study's objective was therefore to identify and analyse the current basis of evidence for perioperative management in distal pancreatectomy. Methods: A standardised questionnaire was sent to 23 European centres recruiting patients for a randomized controlled trial (RCT) on open distal pancreatectomy that would compare suture versus stapler closure of the pancreatic remnant (DISPACT trial, ISRCTN 18452029). Perioperative strategies (e.g., bowel preparation, pain management, administration of antibiotics, abdominal incision, drainages, nasogastric tubes, somatostatin, mobilisation and feeding regimens) were assessed. Moreover, a systematic literature search in the Medline database was performed and retrieved meta-analyses and RCTs were reviewed. Results: All 23 centres returned the questionnaire. Consensus for thoracic epidural catheters (TECs), pain treatment and transverse incisions was found, as well as strong consensus for the placement of intra-abdominal drainages and perioperative single-shot antibiotics. Also, there was consensus that bowel preparation, somatostatin application, postoperative nasogastric tubes and intravenous feeding might not be beneficial. The literature search identified 16 meta-analyses and 19 RCTs demonstrating that bowel preparation, somatostatin therapy and nasogastric tubes can be omitted. Early mobilisation, feeding and TECs seem to be beneficial for patients. The value of drainages remains unclear. Conclusion: Most perioperative standards within the centres participating in the DISPACT trial are in accordance with current available evidence. The need for drainages requires further investigation.

AB - Background: Concomitant treatment in addition to intervention may influence the primary outcome, especially in complex interventions such as surgical trials. Evidence-based standards for perioperative care after distal pancreatectomy, however, have been rarely defined. This study's objective was therefore to identify and analyse the current basis of evidence for perioperative management in distal pancreatectomy. Methods: A standardised questionnaire was sent to 23 European centres recruiting patients for a randomized controlled trial (RCT) on open distal pancreatectomy that would compare suture versus stapler closure of the pancreatic remnant (DISPACT trial, ISRCTN 18452029). Perioperative strategies (e.g., bowel preparation, pain management, administration of antibiotics, abdominal incision, drainages, nasogastric tubes, somatostatin, mobilisation and feeding regimens) were assessed. Moreover, a systematic literature search in the Medline database was performed and retrieved meta-analyses and RCTs were reviewed. Results: All 23 centres returned the questionnaire. Consensus for thoracic epidural catheters (TECs), pain treatment and transverse incisions was found, as well as strong consensus for the placement of intra-abdominal drainages and perioperative single-shot antibiotics. Also, there was consensus that bowel preparation, somatostatin application, postoperative nasogastric tubes and intravenous feeding might not be beneficial. The literature search identified 16 meta-analyses and 19 RCTs demonstrating that bowel preparation, somatostatin therapy and nasogastric tubes can be omitted. Early mobilisation, feeding and TECs seem to be beneficial for patients. The value of drainages remains unclear. Conclusion: Most perioperative standards within the centres participating in the DISPACT trial are in accordance with current available evidence. The need for drainages requires further investigation.

UR - https://www.scopus.com/pages/publications/68949213821

U2 - 10.1186/1745-6215-10-58

DO - 10.1186/1745-6215-10-58

M3 - Review article

C2 - 19630998

AN - SCOPUS:68949213821

SN - 1745-6215

VL - 10

JO - Trials

JF - Trials

M1 - 58

ER -

Perioperative management in distal pancreatectomy: Results of a survey in 23 European participating centres of the DISPACT trial and a review of literature

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