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The Methods of Reconstruction of Pancreatic Digestive Continuity After Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

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Abstract

Background

Pancreatic fistula (PF) is an important factor responsible for the considerable morbidity associated with pancreaticoduodenectomy (PD). There have been many techniques proposed for the reconstruction of pancreatic digestive continuity to prevent fistula formation but which is best is still highly debated. We carried out a systematic review and meta-analysis to determine the effectiveness of methods of anastomosis after PD.

Methods

A full literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, and other resources irrespective of language. Randomized controlled trials (RCTs) were considered for inclusion. Analyses were carried out using RevMan software.

Results

In all, ten RCTs that included a total of 1,408 patients were included. The meta-analysis showed that the PF, postoperative complications, biliary fistula, mortality, reoperation, and length of hospital stay were not statistically different between the pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) groups. The PF, postoperative complications, mortality, and reoperation were not statistically different between the duct-to-mucosa PJ and PJ groups. Binding PJ significantly decreased the PF and postoperative complications compared with conventional PJ. The PF, postoperative complications, and mortality were not statistically different between ligation of the pancreatic duct without anastomosis versus PJ.

Conclusion

No pancreatic reconstruction technique after PD was found to be applicable to all kinds of pancreatic remnants in our systematic review and meta-analysis. Some new approaches such as binding PJ and modified PG will be considered for study in the future.

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References

  1. Winter JW, Cameron JL, Campbell KA et al (2006) 1423 Pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10:1199–1211

    Article  PubMed  Google Scholar 

  2. Buchler MW, Friess H, Wagner M et al (2000) Pancreatic fistula after pancreatic head resection. Br J Surg 87:883–889

    Article  PubMed  CAS  Google Scholar 

  3. Mathur A, Pitt HA, Marine M et al (2007) Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 246:1058–1064

    Article  PubMed  Google Scholar 

  4. Shrikehande SV, Qureshi SS, Rajneesh N et al (2005) Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies? World J Surg 29:1642–1649

    Article  Google Scholar 

  5. Karita A, Yoshida M, Takahashi T (2001) History of pancreaticojejunostomy in pancreaticoduodenectomy: development of more reliable anastomosis technique. J Hepatobiliary Pancreat Surg 8:230–237

    Article  Google Scholar 

  6. Sakorafas GH, Friess H, Balsiger BM, Buchler MW, Sarr MG (2001) Problems of reconstruction during pancreatoduodenectomy. Dig Surg 18:363–369

    Article  PubMed  CAS  Google Scholar 

  7. Yeo CJ, Cameron JL, Lillemoe KD (2000) Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 232:419–429

    Article  PubMed  CAS  Google Scholar 

  8. Takano S, Ito Y, Watanabe Y et al (2000) Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg 87:423–427

    Article  PubMed  CAS  Google Scholar 

  9. Strasberg SM, Drebin JA, Mokadam NA et al (2002) Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg 194:746–758

    Article  PubMed  Google Scholar 

  10. Peng SY, Mou YP, Cai XJ et al (2002) Binding pancreaticojejunostomy is a new technique to minimize leakage. Am J Surg 183:283–285

    Article  PubMed  Google Scholar 

  11. Peng SY, Mou YP, Liu YB et al (2003) Binding pancreaticojejunostomy: 150 consecutive cases without leakage. J Gastrointest Surg 7:898–901

    Article  PubMed  Google Scholar 

  12. Lai EC, Lau SH, Lau WY (2009) Measures to prevent pancreatic fistula after pancreatoduodenectomy: a comprehensive review. Arch Surg 144:1074–1080

    Article  PubMed  Google Scholar 

  13. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  CAS  Google Scholar 

  14. Turpin DL (2005) CONSORT and QUOROM guidelines for reporting randomized clinical trials and systematic reviews. Am J Orthod Dentofacial Orthop 128:681-685; discussion 686

    Google Scholar 

  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  16. Dixon E, Hameed M, Sutherland F, Cook DJ, Doig C (2005) Evaluating meta-analyses in the general surgical literature: a critical appraisal. Ann Surg 241:450–459

    Article  PubMed  Google Scholar 

  17. Fernández-Cruz L, Cosa R, Blanco L, López-Boado MA, Astudillo E (2008) Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg 248:930–938

    Article  PubMed  Google Scholar 

  18. Bassi C, Falconi M, Molinari E et al (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242:767-771; discussion 771-773

    Google Scholar 

  19. Duffas JP, Suc B, Msika S et al (2005) A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg 189:720–729

    Article  PubMed  Google Scholar 

  20. Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222(4):580-588; discussion 588-592

    Google Scholar 

  21. Berger AC, Howard TJ, Kennedy EP et al (2009) Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg 208:738-747; discussion 747-749

    Google Scholar 

  22. Bassi C, Falconi M, Molinari E et al (2003) Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery 134:766–771

    Article  PubMed  Google Scholar 

  23. Chou FF, Sheen-Chen SM, Chen YS, Chen MC, Chen CL (1996) Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. Eur J Surg 162:477–481

    PubMed  CAS  Google Scholar 

  24. Peng SY, Wang JW, Lau WY et al (2007) Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 245:692–698

    Article  PubMed  Google Scholar 

  25. Tran K, Van Eijck C, Di Carlo V et al (2002) Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 236:422-428; discussion 428

    Google Scholar 

  26. Reissman P, Perry Y, Cuenca A et al (1995) Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma. Am J Surg 169:585–588

    Article  PubMed  CAS  Google Scholar 

  27. Lee SE, Jang JY, Lim CS, Kang MJ, Kim SH, Kim MA, Kim SW (2010) Measurement of pancreatic fat by magnetic resonance imaging: predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. Ann Surg 251:932–936

    Article  PubMed  Google Scholar 

  28. Schlitt HJ, Schmidt U, Simunec D et al (2002) Morbidity and mortality associated with pancreatogastrostomy and pancreatojejunostomy following partial pancreatoduodenectomy. Br J Surg 89:1245–1251

    Article  PubMed  CAS  Google Scholar 

  29. Matsumoto Y, Fujii H, Miura K et al (1992) Successful pancreatojejunal anastomosis for pancreatodenectomy. Surg Gynecol Obstet 175:555–562

    PubMed  CAS  Google Scholar 

  30. Tsuji M, Kimura H, Konishi K et al (1998) Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: historical study of 300 patients. Surgery 123:617–621

    Article  PubMed  CAS  Google Scholar 

  31. Hwang TL, Jan YY, Chen MF (1996) Secural pancreaticojejunal anastomosis for the pancreaticoduodenectomy. Hepatogastroenterology 43:275–277

    PubMed  CAS  Google Scholar 

  32. Marcus SG, Cohen H, Ranson JHC (1995) Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg 221:635–648

    Article  PubMed  CAS  Google Scholar 

  33. Buc E, Flamein R, Golffier C et al (2010) Peng’s binding pancreaticojejunostomy after pancreaticoduodenectomy: a French prospective study. J Gastrointest Surg 14:705–710

    Article  PubMed  Google Scholar 

  34. Poon RT, Fan ST, Lo CM et al (2007) External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 246:425–433

    Article  PubMed  Google Scholar 

  35. Alghamdi AA, Jawas AM, Hart RS (2007) Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis. Can J Surg 50:459–466

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, 17 Changle Western Road, Xi’an, 710032, Shanxi Province, China

    Sun Hu Yang, Ke Feng Dou & Wen Jie Song

  2. Department of General Surgery, People’s Hospital of Zhangye City, Zhangye City, Gansu Province, China

    Sun Hu Yang

  3. Core Medical Trainee Year One, Lewisham Healthcare NHS Trust, London, UK

    Neel Sharma

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  1. Sun Hu Yang
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  2. Ke Feng Dou
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  3. Neel Sharma
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  4. Wen Jie Song
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Correspondence to Ke Feng Dou.

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Yang, S.H., Dou, K.F., Sharma, N. et al. The Methods of Reconstruction of Pancreatic Digestive Continuity After Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials. World J Surg 35, 2290–2297 (2011). https://doi.org/10.1007/s00268-011-1159-7

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