Annals of Surgical Oncology

, Volume 14, Issue 6, pp 1825–1834

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

    • Department of Clinical Epidemiology and BiostatisticsMcMaster University
    • Department of SurgeryUniversity of Western Ontario, University Hospital
  • Edward Davies
    • Department of SurgeryUniversity of Western Ontario, University Hospital
  • Regina Kunz
    • Basel Institute for Clinical EpidemiologyUniversity Hospital Basel
  • Matthias Briel
    • Department of Clinical Epidemiology and BiostatisticsMcMaster University
    • Basel Institute for Clinical EpidemiologyUniversity Hospital Basel
  • H. Pavan Koka
    • Department of Clinical Epidemiology and BiostatisticsMcMaster University
    • Department of SurgeryUniversity of Western Ontario, University Hospital
  • Darrin M. Payne
    • Department of Clinical Epidemiology and BiostatisticsMcMaster University
    • Department of SurgeryUniversity of Western Ontario, University Hospital
  • Shona E. Smith
    • Department of SurgeryUniversity of Western Ontario, University Hospital
  • Hui-Ping Hsu
    • Department of SurgeryNational Cheng Kung University Hospital
  • Pin-Wen Lin
    • Department of SurgeryNational Cheng Kung University Hospital
  • Christian Bloechle
    • Department of SurgeryUniversity Hospital Eppendorf
  • Karl-Joseph Paquet
    • Department of SurgeryHeinz Kalk-Hospital
  • Gordon H. Guyatt
    • Department of Clinical Epidemiology and BiostatisticsMcMaster University
    • Department of MedicineMcMaster University
Article

DOI: 10.1245/s10434-006-9330-3

Cite this article as:
Karanicolas, P.J., Davies, E., Kunz, R. et al. Ann Surg Oncol (2007) 14: 1825. doi:10.1245/s10434-006-9330-3

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 We included published and unpublished randomized controlled trials.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.

Keywords

Pancreatic cancerPancreaticoduodenectomyWhipple procedurePylorusSystematic reviewMeta-analysis

Copyright information

© Society of Surgical Oncology 2007