Meta-analysis of pancreaticogastrostomy <i>versus</i> pancreaticojejunostomy after pancreaticoduodenectomy

Xiong, Junjie; Tan, Chunlu; Szatmary, Peter; Huang, Wei; Ke, Nengwen; Hu, Weiming; Nunes, Quentin; Sutton, Robert; Liu, X B

doi:10.1002/bjs.9553

Cited by 118 publications

(82 citation statements)

References 49 publications

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“…Numerous attempts have been made to reduce the frequency of pancreatic fistula using different surgical techniques, but none have proved superior. A number of meta-analyses indicate that a pancreaticogastrostomy has a slightly lower rate of leakage compared with a pancreaticojejunostomy [52,53]. Other risk factors for pancreatic fistulas include a high BMI, a small pancreatic duct diameter and a soft pancreatic texture [54,55].…”

Section: Operability Assessmentmentioning

confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology. Historical remarks & present stateThe first known description of pancreatic cancer is attributed to Giovanni Battista Morgagni in his 1761 publication 'de Sedibus Et Causis Morborum Per Anatomen Indagatis Libri Quinque' [1]. However, the lack of a microscopic evaluation makes the true diagnosis of ductal adenocarcinoma uncertain. The next important advancement in our understanding of pancreatic cancer did not come until 1858, when Jacob Mendez Da Costa revisited Morgagni's original work and also described the first microscopic diagnosis of adenocarcinoma, manifesting pancreatic cancer as a true disease entity [2].The history of pancreatic surgery is fairly recent and involves a combination of brave surgical pioneers, the development of surgical anesthesia and modern aseptic techniques. Some landmarks in the history of pancreatic surgery deserve to be mentioned. The first reported attempt at a pancreaticoduodenectomy was performed in 1898 by the Italian surgeon Alessandro Codivilla for a tumor involving the head of the pancreas [3]; however, the patient did not survive the postoperative period. In the same year, William Stewart Halsted from Johns Hopkins Hospital performed the first successful resection for ampullary cancer by excising portions of the duodenum and the pancreas [4]. The first successful pancreaticoduodenectomy is credited to the German surgeon Walther Carl Eduard Kausch, as part of a two-stage procedure [5]. In 1914, Georg Hirschel performed the first successful pancreaticoduodenectomy in one stage [6] and then in 1935, Allen Oldfather Whipple presented the results of a two-stage procedure involving the resection of the head of the pancreas and duodenum for ampullary carcinoma at the annual meeting of the American Surgical Association, which renewed interest in pancreatic surgery [7]. During his career, Whipple performed 37 pancreaticoduodenectomies, with the procedure evolving into a one-stage technique [8,9], and 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-2003 2004-2008 2009-2013 Period of diagnosis Whipple is generally credited with popularizing the operation that still bears his name. In 1937, Alexander Brunschwig performed the first successful pancreaticoduodenectomy for pancreatic adenocarcinoma [10]. Today, with the concentration of experience in high-volume hospitals, pancreatic surgery has become a safe procedure associated with an operative mortality below 3% [11][12][13]. While major advances have been made ...

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Section: Operability Assessmentmentioning

confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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“…[3][4][5] Many variations in operative techniques were considered to decrease the incidence of these complications. [16][17][18][19][20] One such variation is addition of Braun's Enteroenterostomy (BEE) to the standard reconstruction. Few published series have shown to reduce the morbidity with the addition of BEE to the standard reconstruction by decreasing DGE and some have shown even decrease in POPF rates.…”

Section: Discussionmentioning

confidence: 99%

Addition of Braun enteroenterostomy to standard reconstruction in pancreaticoduodenectomy: impact on early outcomes

et al. 2017

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INTRODUCTIONPancreaticoduodenectomy (Whipple procedure) is the standard treatment for operable carcinomas of the head of the pancreas, periampullary tumors and in some cases of chronic pancreatitis. Advances in surgical skills and postoperative care have resulted in mortality rates of less than 5%.1 Despite significant improvements in the safety and efficacy of pancreatic surgery, morbidity still remains high in the range of 30% to 65%.2 Delayed gastric emptying (DGE) and Postoperative Pancreatic fistula (POPF) remains the major causes of morbidity.The exact cause of DGE following pancreaticoduodenectomy is not known. It appears to be multifactorial. [3][4][5] Technical factors in the construction of gastroenterostomy have been implicated in the development of DGE. Significant edema or kinking at this anastomosis may be a factor in the development of DGE. 6 ABSTRACT Background: Morbidity following Pancreaticoduodenectomy still remains high. Few studies have shown decrease in morbidity with the addition of Braun Enteroenterostomy (BEE). Aim of the present study was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy. Methods: In this prospective randomized controlled study, all patients who underwent Pancreaticoduodenectomy from June 2012 to July 2016 were included. They were randomized to undergo either standard reconstruction (Group A) or with addition of Braun Enteroenterostomy to standard reconstruction (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of <0.05 was considered significant. Results: 104 patients were included in the study. Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients who had addition of BEE to standard reconstruction. The demographic profile, tumour characteristics, and biochemical profile were similar in 2 groups. Mean operating time and Intra operative blood loss were similar. The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56, 25% in group A versus 8/48, 16.6% in group B; p = 0.42). The incidence of Delayed Gastric Emptying (DGE) was not statistically different in 2 groups (20/56, 35.7% in group A versus 12/48, 25% in group B; p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 days versus 10.7 days; p=0.68). Conclusions:The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun Enteroenterostomy to standard reconstruction.

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“…Regarding internal stenting of the anastomosis, earlier non-randomized studies showed decreased leak rate and duration of hospital stay [9,10]. Several well-designed studies failed to show advantage of internal stenting [11,12].Various prospective and retrospective studies evaluating duct to mucosa pancreatic anastomosis showed this technique to be safe and decreased the incidence of complication and mortality [13 -16].Bile leak rate of 4% is reported in our study is comparable with biliary complications mentioned in the literature [19].Intraabdominal collection was observed in 8% of the patients that is comparable with similar other studies and it is usually due to leak from the gastrojejunostomy, hepatico jejunostomy, or pancreatic anastomosis [17,18].…”

Section: Duct To Mucosa Pancreatico Gastrostomy With Internal Stentinmentioning

confidence: 98%

Duct To Mucosa Pancreatico Gastrostomy With Internal Stenting After Pancreaticoduodenectomy - Retrospective Study Of Outcome In 25 Consecutive Cases.

Sureshkumar¹,

Arulkumar²,

Vishwanathan³

2017

IOSR JDMS

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Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy

Abstract: Meta-analysis of four RCTs based on ISGPF criteria, and seven RCTs using non-standard criteria, revealed that PG reduced the incidence of POPF after PD compared with PJ.

Cited by 118 publications

References 49 publications

Pancreatic Cancer: Yesterday, Today and Tomorrow

Pancreatic Cancer: Yesterday, Today and Tomorrow

Addition of Braun enteroenterostomy to standard reconstruction in pancreaticoduodenectomy: impact on early outcomes

Duct To Mucosa Pancreatico Gastrostomy With Internal Stenting After Pancreaticoduodenectomy - Retrospective Study Of Outcome In 25 Consecutive Cases.

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