Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: A meta-analysis of randomized control trials

Chen, Zhihao; Song, Xin-Ming; Yang, Dongjie; Li, Y.; Xu, Kaiwu

doi:10.1016/j.ejso.2014.06.009

Cited by 30 publications

(15 citation statements)

References 44 publications

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“…[5,6] According to the studies examined here, the POPF-related mortality rate was not statistically different between PJ and PG groups (1.0% vs. 0.8%; P = .856; Table 1), nor did the overall mortality rate differ (2.2% vs. 2.2%; P = .999). The superiority of PG compared with PJ in decreasing the mortality rate was one of the main topics examined in 16 systematic reviews and meta-analyses that have been carried out until now [17–32] ; 14 confirmed our findings that there were no differences in the overall PO mortality rate, [18–20,22–32] while 2 reported a lesser overall PO mortality rate for PG with respect to PJ. [17,21] He et al, [21] in particular, found a lesser mortality rate for PG with respect to PJ (2.6% vs. 7.1%, P < .00001) in 22 observational clinical studies examining 3199 patients included in their systematic review and meta-analysis.…”

Section: Discussionsupporting

confidence: 77%

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

168

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Background:Pancreatoduodenectomy (PD) is one of the most technically demanding operations challenging surgeons, and a postoperative pancreatic fistula (POPF) can complicate an otherwise uneventful postoperative (PO) course. This review examined the methods and procedures used to prevent postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD).Methods:A comprehensive systematic search of the literature was performed using PubMed (Medline), Embase, Web of science, and the Cochrane databases for studies published between January 1, 1990 and December 31, 2015. English language articles involving at least 100 patients undergoing PDs carried out in centers performing at least 10 PDs/y were screened for data regarding the Grade of any POPFs according to the definition of the International Study Group on Pancreatic Fistula (ISGPF) and the overall rate of PO mortality related to POPF.Results:We reviewed 7119 references through the major databases, and an additional 841 studies were identified by cross-checking the bibliographies of the full-text articles retrieved. After excluding 7379 out of 7960 studies, because they did not meet the eligibility criteria, the full texts of 581 articles were examined; 96 studies were excluded at this point, because they concerned partially or totally duplicate data that had already been reported. The remaining 485 articles were screened carefully for POPF-related mortality and POPF Grades as defined by the ISGPF. Of the 485 articles, 208 reported the POPF-related PO mortality rate and 162 the Grades (A, B, and C) of POPFs in 60,739 and 54,232 patients, respectively. The POPF-related mortality rates after pancreatojejunostomy and pancreatogastrostomy were similar but were less (0.5% vs. 1%; P = .014) when an externally draining, trans-anastomotic stent was placed intraoperatively. The incidence of the different Grades of POPF Grade was quite variable, but Grade C POPFs were associated with a PO mortality rate of 25.7% (range 0–100%).Conclusions:The POPF-related mortality rate has remained at approximately 1% over the past 25 years. Only externally draining, trans-anastomotic stents decreased the POPF-related mortality rate. However, adequately designed venting drains were never tested in randomized controlled trials (RCTs).

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Section: Discussionsupporting

confidence: 77%

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

168

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“…Chen et al proposed a meta-analysis comparing PG vs PJ and concluded that PG reduces the incidence of PF and of the other major complications after PD [54]. Probably, PF rate among those techniques may be discordant because of a not standardized PF definition until 2006.…”

Section: Discussionmentioning

confidence: 94%

Pancreatic fistula following pancreatoduodenectomy. Evaluation of different surgical approaches in the management of pancreatic stump. Literature review

Conzo

Gambardella

Tartaglia

et al. 2015

International Journal of Surgery

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Pancreatoduodenectomy is the gold standard operation for malignant and benign diseases of the pancreas and periampullary region. Even if improvements in intensive care management and surgical technique have dramatically reduced postoperative mortality after pancreatic surgery, morbidity remains high (30-50%), also in specialized pancreatic units. In order to reduce postoperative complications, particularly pancreatic fistula, different surgical techniques and their modifications have been proposed. In order to determine the better management of the pancreatic stump after pancreatoduodenectomy, the Authors analysed and compared derivative - pancreaticojejunal, pancreaticogastrostomy - vs no-derivative technique - pancreatic stump closure (duct ligation or mechanical suture, duct occlusion by fibrin glue or cyanoacrylate). A systematic research of the English literature, including major meta-analysis articles, clinical randomized trials, retrospective studies and systematic reviews was performed, analysing the risk factors and the incidence of short-medium term postoperative complications. Up to now, even if derivative procedures are preferred as gold standard the best method to deal a pancreatic stump is still controversial and remains matter of research. Pancreatic surgeons must have more than one technique for managing the pancreatic remnant.

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“…Several strategies have been proposed to decrease the incidence of POPF but only a few are potentially successful. This includes pancreatogastric anastomosis, external drainage of the pancreatic anastomosis, pre‐operative administration of pasireotide (Novartis Oncology, Basel, Switzerland) ® . Nevertheless, even in the intervention arms of these successful studies the incidence of POPF was still as high as 10%, and further improvements are, therefore, needed.…”

Section: Introductionmentioning

confidence: 99%