Frey procedure for chronic pancreatitis: Evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: A meta-analysis

Zhou, Yanming; Shi, Bin; Wu, Lupeng; Wu, Xiurong; Li, Yumin

doi:10.1016/j.pan.2015.05.466

Cited by 46 publications

(38 citation statements)

References 29 publications

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“…Compared with Beger's procedure, the Frey procedure had a reduced operation time and was associated with lower morbidity. [ 48 ] Our study corroborates these findings and suggests that resection plus drainage procedures (both Frey and Berne procedures) had better outcomes when performed early.…”

Section: Discussionsupporting

confidence: 85%

“…A recent meta-analysis [ 47 ] suggested that duodenum-preserving pancreatic resection (Beger's or Frey procedures) had similar outcomes to PD with respect to mortality, adverse events and quality of life, but may be associated with a shorter hospital stay and less blood loss. A further meta-analysis [ 48 ] showed that the Frey procedure is safe and effective, which when compared to PD is followed by fewer overall complications and better short and long term pain relief, pancreatic function preservation and quality of life. Compared with Beger's procedure, the Frey procedure had a reduced operation time and was associated with lower morbidity.…”

Section: Discussionmentioning

confidence: 99%

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Earlier surgery improves outcomes from painful chronic pancreatitis

Ke¹,

Jia²,

Huang

et al. 2018

Medicine

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The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a single center from 2007 to 2012.The early surgery group (n = 98) more frequently than the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P = .002) and pancreatic mass +/− ductal dilatation (47% vs 27%, P < .001), but less frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation alone (31% vs 71%, P < .001), parenchymal calcification (91.8% vs 100%, P < .001) or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033).Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Earlier surgery improves outcomes from painful chronic pancreatitis

Ke¹,

Jia²,

Huang

et al. 2018

Medicine

View full text Add to dashboard Cite

show abstract

“…Through the literature search, there have been approximately 7 meta-analyses in recent years that compare different surgical methods (PD/PPPD, DPPHR, the Beger procedure, and the Frey procedure) for the treatment of chronic pancreatitis, [16,40–42,44] although similar conclusions were obtained. To provide more evidence for clinical decision-making, this study incorporated the updated randomized controlled trials with different follow-up times and a more detailed analysis (i.e., long-term quality of life) that was assessed in the functional and symptom scale scores of surviving patients.…”

Section: Discussionmentioning

confidence: 92%

Surgical strategies in the treatment of chronic pancreatitis

et al. 2017

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Background:Chronic pancreatitis (CP) is a common and frequently occurring disease. Pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and duodenum-preserving pancreatic head resection (DPPHR) are important treatment options for patients with chronic pancreatitis. The Beger and Frey procedures are 2 main duodenum-preserving techniques in duodenum-preserving pancreatic head resection (DPPHR) strategies. We conducted this systematic review and meta-analysis to compare the clinical efficacy of DPPHR versus PD, the Beger procedure versus PD, the Frey procedure versus PD, and the Beger procedure versus the Frey procedure in the treatment of pancreatitis. The optimal surgical option for chronic pancreatitis is still under debate. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of different surgical strategies for chronic pancreatitis.Methods:Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched with the limitations of human subjects and randomized controlled trials (RCTs) text. Data were extracted by 2 of the coauthors independently and analyzed using the RevMan statistical software, version 5.3. Weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias.Results:Seven studies involving a total of 385 patients who underwent the surgical treatments were assessed. The methodological quality of the trials ranged from low to moderate and included PD (n = 134) and DPPHR (n = 251 [Beger procedure = 100; Frey procedure = 109; Beger or Frey procedure = 42]). There were no significant differences between DPPHR and PD in post-operation mortality (RR = 2.89, 95% CI = 0.31–26.87, P = 0.36), pain relief (RR = 1.09, 95% CI = 0.94–1.25, P = 0.26), exocrine insufficiency (follow-up time > 60 months: RR = 0.91, 95% CI = 0.72–1.15, P = 0.41), and endocrine insufficiency (RR = 0.75, 95% CI = 0.52–1.08, P = 0.12). Concerning the follow-up time < 60 months, the DPPHR group had better results of exocrine insufficiency (RR = 0.22, 95% CI = 0.08–0.62, P = 0.04). However, operation time (P < 0.0001), blood transfusion (P = 0.02), hospital stay (P = 0.0002), postoperation morbidity (P = 0.0007), weight gain (P < 0.00001), quality of life (P = 0.01), and occupational rehabilitation (P = 0.007) were significantly better for patients who underwent the DPPHR procedure compared with the PD procedure. The comparison results of the Frey procedure and PD showed that both procedures had an equal effect in the pain relief, postoperation mortality, exocrine and endocrine function, and quality of life (QoL) (P > 0.05), whereas patients who underwent the Frey procedure had significantly reduced operative times (P < 0.05) and less blood transfusions (P < 0.05). Comparing the Beger procedure to the PD procedure, there were no significant differences in hospital stay, blood transfusion, postoperation morbidity or mortality, pain ...

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“…Compared to PD, DPPHR is equally effective in terms of postoperative pain relief, overall morbidity and incidence of postoperative endocrine insufficiency [ 75 ]. A metaanalysis from 2015 compared the Frey and Beger procedures, and pain relief was achieved in 89% of cases using the Frey procedure in PD with a shorter operation time and lower overall morbidity [ 76 ]. 18% of patients who had undergone DPPHR developed a stricture in the reinsertion site, while it was only 4% in PD [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic pancreatitis: Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group

et al. 2017

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IntroductionChronic pancreatitis is an inflammatory disease associated with structural and functional damage to the pancreas, causing pain, maldigestion and weight loss and thus worsening the quality of life.Aims and methodsOur aim was to find correlations from a multicentre database representing the epidemiological traits, diagnosis and treatment of the disease in Hungary. The Hungarian Pancreatic Study Group collected data prospectively from 2012 to 2014 on patients suffering from chronic pancreatitis. Statistical analysis was performed on different questions.ResultsData on 229 patients (74% male and 26% female) were uploaded from 14 centres. Daily alcohol consumption was present in the aetiology of 56% of the patients. 66% of the patients were previously treated for acute exacerbation. One third of the patients had had previous endoscopic or surgical interventions. Pain was present in 69% of the cases, endocrine insufficiency in 33%, diarrhoea in 13% and weight loss in 39%. Diagnosis was confirmed with US (80%), CT scan (52%), MRI-MRCP (6%), ERCP (39%), and EUS (7,4%). A functional test was carried out in 5% of the patients. In 31% of the cases, an endoscopic intervention was performed with the need for re-intervention in 5%. Further elective surgical intervention was necessitated in 44% of endoscopies. 20% of the registered patients were primarily treated with surgery. The biliary complication rate for surgery was significantly smaller (2%) than endoscopy (27%); however, pancreatic complications were higher in the patients treated with surgery. Patients who smoked regularly needed significantly more surgical intervention following endoscopy (66.7% vs. 26.9%, p = 0.002) than non-smokers, and the ratio of surgical intervention alone was also significantly higher (27.3% vs. 10.8%, p = 0.004). The ratio of surgery in patients who smoked and drank was significantly higher (30.09% vs. 12.5%, p = 0.012) than in abstinent and non-smoking patients, similarly to the need for further surgical intervention after endoscopic treatment (71.43% vs. 27.78%, p = 0.004).ConclusionsAccording to the data analysed, the epidemiological data and the aetiological factors in our cohort differ little from European trends. The study highlighted the overuse of ERCP as a diagnostic modality and the low ratio of use of endoscopic ultrasonography. The results proved that alcohol consumption and smoking represent risk factors for the increased need for surgical intervention. Chronic pancreatitis should be treated by multidisciplinary consensus grounded in evidence-based medicine.

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Frey procedure for chronic pancreatitis: Evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: A meta-analysis

Cited by 46 publications

References 29 publications

Earlier surgery improves outcomes from painful chronic pancreatitis

Earlier surgery improves outcomes from painful chronic pancreatitis

Surgical strategies in the treatment of chronic pancreatitis

Chronic pancreatitis: Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group

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