Pancreatic outflow tract reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials

World Journal of Surgical Oncology

Yuan Li¹  Yu Ke Yan¹  Bao Long Dong¹  Xiao Jun Yang²  Xin Xin Wang³ 

[1] Department of General Surgery, Gansu Provincial Hospital, No. 204 Donggang West Road, 730000, Lanzhou, Gansu Province, China;Department of General Surgery, Gansu Provincial Hospital, No. 204 Donggang West Road, 730000, Lanzhou, Gansu Province, China;Peoples Clinical Medicine College, Lanzhou University, 730000, Lanzhou, Gansu Province, China;Gansu key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, 730000, Lanzhou, Gansu Province, China;Gansu Research Center of Prevention and Control Project for Digestive Oncology, Gansu Provincial Hospital, 730000, Lanzhou, Gansu Province, China;Department of General Surgery, Gansu Provincial Hospital, No. 204 Donggang West Road, 730000, Lanzhou, Gansu Province, China;The 1st Clinical Medicine College, Gansu University of Chinese Medicine, 730000, Lanzhou, Gansu Province, China;

关键词: Pancreaticoduodenectomy;    Pancreaticogastrostomy;    Pancreaticojejunostomy;    Meta-analysis;    Pancreatic fistula;    Delayed gastric emptying;   

DOI  :  10.1186/s12957-021-02314-2

来源: Springer

【 摘 要 】

BackgroundTo evaluate the outcomes of pancreaticogastrostomy and pancreaticojejunostomy after pancreatoduodenectomy with the help of a meta-analysis.MethodsRandomized controlled trials comparing pancreaticogastrostomy and pancreaticojejunostomy were searched electronically using PubMed, The Cochrane Library, and EMBASE. Fixed and random-effects were used to measure pooled estimates. Research indicators included pancreatic fistula, delayed gastric emptying, postoperative hemorrhage, intraperitoneal fluid collection, wound infection, overall postoperative complications, reoperation, and mortality.ResultsOverall, 10 randomized controlled trials were included in this meta-analysis, with a total of 1629 patients. The overall incidences of pancreatic fistula and intra-abdominal collections were lower in the pancreaticogastrostomy group than in the pancreaticojejunostomy group (OR=0.73, 95% CI 0.55~0.96, p=0.02; OR=0.59, 95% CI 0.37~0.96, p=0.02, respectively). The incidence of B/C grade pancreatic fistula in the pancreaticogastrostomy group was lower than that in the pancreaticojejunostomy group, but no significant difference was observed (OR=0.61, 95%CI 0.34~1.09, p=0.09). Postoperative hemorrhage was more frequent in the pancreaticogastrostomy group than in the pancreaticojejunostomy group (OR=1.52; 95% CI 1.08~2.14, p=0.02). No significant differences in terms of delayed gastric emptying, wound infection, reoperation, overall postoperative complications, mortality, exocrine function, and hospital readmission were observed between groups.ConclusionThis meta-analysis suggests that pancreaticogastrostomy reduces the incidence of postoperative pancreatic fistula and intraperitoneal fluid collection but increases the risk of postoperative hemorrhage compared with pancreaticojejunostomy.

【 授权许可】

CC BY