Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-analysis of RCTs Applying the ISGPS (2016) Criteria

Abstract

The goal of our study was to compare the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on the incidence of complications after pancreaticoduodenectomy. A systematic search was performed using RevMan 5.3 software. A meta-analysis showed that PG was not superior to PJ in terms of postoperative pancreatic fistula (POPF). In multicenter randomized controlled trials, the incidence of POPF was lower in patients undergoing PG than in those undergoing PJ. However, PG was associated with an increased risk of postoperative intraluminal hemorrhage, but no significant difference was observed between 2-layer PG and PJ. No significant differences were found in the rate of overall delayed gastric emptying, biliary fistula, reoperation, mortality, and morbidity. PG and PJ have similar incidences of POPF, but PG could be slightly superior to PJ in multicenter trials. However, this analysis verifies that PG has a higher rate of postpancreatectomy hemorrhage. Of note, a 2-layer anastomosis could reduce the occurrence of postpancreatectomy hemorrhage.

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

“…Of the several available techniques, pancreaticogastrostomy (PG) and pancreatojejunostomy (PJ) are the most commonly performed. Some RCTs[28-35] and meta-analyses[36-44] have compared PG and PJ. Topal et al[32] reported comparative results of the occurrences of POPFs (grade B or C) in an RCT with 329 patients.…”

“…Several meta-analysis results on this issue have been reported and demonstrated the apparent superiority of PG in the risk for POPF despite the slight difference in the included studies[36-44]. However, PJ was found to have physiological advantages compared to PG although the follow-up periods were relatively short[34,45-48].…”

Effects of Preoperative Malnutrition on Postoperative Surgical Outcomes and Quality of Life of Elderly Patients with Periampullary Neoplasms: A Single-Center Prospective Cohort Study

“…Surgical mortality rates have declined following advances in surgical techniques and the perioperative care associated with PD. However, the complexity of the surgical procedure leads to considerable morbidity after PD 2,3. With the increase in life expectancy in the fast-growing population of elderly patients, pancreatic procedures are increasingly being performed in this patient population.…”

Risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

“…These risk factors can be categorized into 3 groups: The technically demanding group, intraoperative volume status–related group, and poor general condition group (Figure 2 ). The risk factors in the technically demanding group (soft pancreas[ 2 , 5 , 6 , 9 ], small pancreatic duct[ 6 , 9 , 29 ], extrapancreatic lesion[ 6 ], absence of preoperative pancreatitis or low lipase level[ 30 ], absence of preoperative endoscopic biliary decompression, absence of neoadjuvant radiotherapy, and high BMI[ 7 ]) indicate potential difficulty in reconstructing the pancreatic-enteric anastomosis, which could cause POPF. Patients with pancreatic cancer, chronic pancreatitis, or neoadjuvant treatment have increased pancreatic fibrosis and a lower incidence of POPF than other PD patients[ 30 , 31 ].…”

“…In this way, we expect our platform to help select patients who need more intense therapy and establish effective (and cost-effective) treatment strategies for POPF. Various mitigation strategies have been proposed to reduce the occurrence and morbidity of POPF, including technical variations, such as, pancreaticogastrostomy reconstruction[ 2 , 42 ], dunking/invaginating anastomosis[ 1 , 43 , 44 ], absorbable mesh patches[ 45 , 46 ], and the use of intraperitoneal drains[ 29 ], anastomotic stents[ 47 ], and prophylactic somatostatin analogues[ 4 , 48 , 49 ]. As a part of those efforts, we have an ongoing trial of this risk score wherein we are applying a somatostatin analogue during postoperative days 0–3 in high-risk patients.…”