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Is there comparable morbidity in pylorus-preserving and pylorus-resecting pancreaticoduodenectomy? A meta-analysis

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Abstract

Pancreaticoduodenectomy (PD) is the most effective treatment for patients with pancreatic head or periampullary lesions. Two major strategies exist: pylorus-preserving pancreaticoduodenectomy (PPPD) and pylorus-resecting pancreaticoduodenectomy (PRPD). However, it is yet unclear regarding the morbidity after PPPD and PRPD. This study analyzed the morbidity after PPPD and PRPD to determine the optimal surgical treatment of masses in the pancreatic head or periampullary region. A systematic search of databases identifying randomized controlled trials (RCTs) from the Cochrane Library, PubMed, EMBASE and Web of Science was performed. Outcome was compared by postoperative morbidity including overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding, biliary leakage, ascites and delayed gastric emptying (DGE) rate between PPPD and PRPD. The DGE rate in the PRPD subgroups (conventional PD [CPD] and subtotal stomach-preserving PD [SSPPD], respectively) was also analyzed. The results showed that 9 RCTs including 722 participants were included for meta-analysis. Among these RCTs, 7 manuscripts described PRPD as CPD, and 2 manuscripts described PRPD as SSPPD. There were no significant differences in the overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding, or biliary leakage between PPPD and PRPD. There was a lower rate of DGE with PRPD than that with PPPD (RR=2.15, P=0.03, 95% CI, 1.09–4.23). Further subgroup analysis indicated a comparable DGE rate for the CPD but a lower DGE rate for the SSPPD group than the PPPD group. However, the result did not indicate any difference between CPD and SSPPD regarding the DGE rate (P=0.92). It is suggested that PPPD is comparable to PRPD in overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding and biliary leakage. The current data are not sufficient to draw a conclusion regarding which surgical procedure is associated with a lower postoperative DGE rate. Our conclusions were limited by the available data. Further evaluations of RCTs are needed.

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Author information

Authors and Affiliations

  1. Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Qi-jun Chen  (陈琦军), Zhi-qiang He  (何志强), Yu-shun Zhang  (张宇舜) & He-shui Wu  (吴河水)

  2. Community Health Service Center, the 9th Hospital of Wuhan, Wuhan, 430081, China

    Yan Yang  (杨 艳)

  3. Key Laboratory of Geriatrics of Health Ministry, Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Xing-lin Chen  (陈星霖)

  4. Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People’s Hospital, Chengdu, 610072, China

    Hong-ji Yang  (杨洪吉), Shi-kai Zhu  (朱世凯), Ping-yong Zhong  (钟平勇) & Chong Yang  (杨 冲)

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  1. Qi-jun Chen  (陈琦军)
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  2. Zhi-qiang He  (何志强)
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  3. Yan Yang  (杨 艳)
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  5. Xing-lin Chen  (陈星霖)
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  7. Shi-kai Zhu  (朱世凯)
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  8. Ping-yong Zhong  (钟平勇)
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  9. Chong Yang  (杨 冲)
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  10. He-shui Wu  (吴河水)
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Corresponding authors

Correspondence to Chong Yang  (杨 冲) or He-shui Wu  (吴河水).

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The authors contributed equally to this work.

This project was supported by the National Natural Science Foundation of China (No. 81372261).

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Chen, Qj., He, Zq., Yang, Y. et al. Is there comparable morbidity in pylorus-preserving and pylorus-resecting pancreaticoduodenectomy? A meta-analysis. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 35, 793–800 (2015). https://doi.org/10.1007/s11596-015-1509-z

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  • DOI: https://doi.org/10.1007/s11596-015-1509-z

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