Pancreaticojejunostomy is comparable to pancreaticogastrostomy after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials
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To perform an up-to-date meta-analysis of randomized controlled trials (RCTs) comparing pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) in order to determine the safer anastomotic technique. Compared to existing meta-analysis, new RCTs were evaluated and subgroup analyses of different anastomotic techniques were carried out.
We conducted a bibliographic research using the National Library of Medicine’s PubMed database from January 1990 to July 2015 of RCTs. Only RCTs, in English, that compared PG versus all types of PJ were selected. Data were independently extracted by two authors. We performed a quantitative systematic review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A random-effect model was applied. Statistical heterogeneity was assessed using the I 2 and χ 2 tests. Primary outcomes were rate of overall and clinically significant pancreatic fistula (POPF).
Ten RCTs were identified including 1629 patients, 826 undergoing PG and 803 undergoing PJ. RCTs showed significant heterogeneity regarding definitions of POPF, perioperative management, and characteristics of pancreatic gland. No significant differences were found in the rate of overall and clinically significant POPF, morbidity, mortality, reoperation, and intra-abdominal sepsis when PG was compared with all types PJ or when subgroup analysis (double-layer PG with or without anterior gastrotomy versus duct to mucosa PJ and single-layer PG versus single-layer end-to-end/end-to-side PJ) were analyzed.
PG is not superior to PJ in the prevention of POPF. Current RCTs have major methodological limitations with significant heterogeneity in regard to surgical techniques, definition of POPF/complications, and perioperative management.
KeywordsMeta-analysis Pancreaticojejunostomy Pancreaticogastrostomy Pancreatic fistula Randomized trial
There are no sources of financial support.
Stefano Crippa is responsible for the conception and design of the project, acquisition, analysis, and interpretation of the data and main author for drafting the manuscript.
Roberto Cirocchi contributed to the conception and design of the study; assisted in the acquisition of the data, interpretation of the results, drafting, and critical review of the paper; and performed the statistical analysis.
Justus Randolph assisted in the statistical analysis, drafting, and in the critical review of the paper.
Stefano Partelli, Giulio Belfiori, Alessandra Piccioli, and Amilcare Parisi assisted in the interpretations of the results and critical review of the paper.
Massimo Falconi contributed to the conception and design of the study and assisted in the interpretation of the results, drafting, and critical review of the paper.
Compliance with ethical standards
Conflicts of interest
All authors declare no conflicts of interests.
- 3.Chen YJ, Lai EC, Lau WY, Chen XP (2014) Enteric reconstruction of pancreatic stump following pancreaticoduodenectomy: a review of the literature. Int J Surg S1743-9191(14):00159–9Google Scholar
- 13.Zhang X, Ma L, Gao X, et al. (2014) Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Surg Today Sep 26Google Scholar
- 16.Hallet J, Zih FS, Deobald RG, et al. (2014) The impact of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction on pancreatic fistula after pancreaticoduodenectomy: meta-analysis of randomized controlled trials. HPB Jul 7Google Scholar
- 17.Menahem B, Guittet L, Mulliri A, Alves A, Lubrano J (2014) Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials. Ann Surg Jun 27Google Scholar
- 18.Liu FB, Chen JM, Geng W, et al. (2014) Pancreaticogastrostomy is associated with significantly less pancreatic fistula than pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of seven randomized controlled trials. HPB Jun 3Google Scholar
- 19.Ma S, Li Q, Dai W, Pan F (2014) Pancreaticogastrostomy versus pancreaticojejunostomy. J Surg Res May 15Google Scholar
- 23.Grendar J, Ouellet JF, Sutherland F, et al. (2015) In search of the best reconstructive technique in the Whipple operation: pancreaticojejunostomy versus pancreaticogastrostomy. Can J Surg Apr 1Google Scholar
- 24.Keck T, Wellner UF, Bahra M, et al. (2015) Pancreatogastrostomy versus pancreatojejunostomy for reconstruction after pancreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg Jul 1Google Scholar