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01-06-2007

The Pylorus: Take It or Leave It? Systematic Review and Meta-Analysis of Pylorus-Preserving versus Standard Whipple Pancreaticoduodenectomy for Pancreatic or Periampullary Cancer

Authors: Paul J. Karanicolas, MD, Edward Davies, MD, Regina Kunz, MD, MSc, Matthias Briel, MD, H. Pavan Koka, MD, Darrin M. Payne, MD, Shona E. Smith, MD, Hui-Ping Hsu, MD, Pin-Wen Lin, MD, Christian Bloechle, MD, Karl-Joseph Paquet, MD, Gordon H. Guyatt, MD, MSc

Published in: Annals of Surgical Oncology | Issue 6/2007

Abstract

Background

Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer.

Methods

We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity.

Results

Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53–92), with 284 mL less blood loss (P < .001, 95% CI, 176–391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25–1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences.

Conclusions

Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.

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Title: The Pylorus: Take It or Leave It? Systematic Review and Meta-Analysis of Pylorus-Preserving versus Standard Whipple Pancreaticoduodenectomy for Pancreatic or Periampullary Cancer
Authors: Paul J. Karanicolas, MD
Edward Davies, MD
Regina Kunz, MD, MSc
Matthias Briel, MD
H. Pavan Koka, MD
Darrin M. Payne, MD
Shona E. Smith, MD
Hui-Ping Hsu, MD
Pin-Wen Lin, MD
Christian Bloechle, MD
Karl-Joseph Paquet, MD
Gordon H. Guyatt, MD, MSc
Publication date: 01-06-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9330-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Pylorus: Take It or Leave It? Systematic Review and Meta-Analysis of Pylorus-Preserving versus Standard Whipple Pancreaticoduodenectomy for Pancreatic or Periampullary Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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