Is there comparable morbidity in pyloruspreservin

Authors: Qijun Chen Zhiqiang He Yan Yang Yushun Zhang Xinglin Chen Hongji Yang Shikai Zhu Pingyong Zhong Chong Yang Heshui Wu

Publish Date: 2015/12/16

Volume: 35, Issue: 6, Pages: 793-800

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Abstract

Pancreaticoduodenectomy PD is the most effective treatment for patients with pancreatic head or periampullary lesions Two major strategies exist pyloruspreserving pancreaticoduodenectomy PPPD and pylorusresecting 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 stomachpreserving PD SSPPD respectively was also analyzed The results showed that 9 RCTs including 722 participants were included for metaanalysis 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=215 P=003 95 CI 109–423 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=092 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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