Abstract
Objective: To define the effectiveness of different anastomosis on clinically relevant postoperative fistula in patients with soft pancreas using the newest version of the fistula definition and criteria.Background: Different criteria of clinically relevant postoperative pancreatic fistula (POPF) result in the optimal anastomosis technique remaining controversial.Methods: PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov were systematically searched up to 20 April 2020, and were evaluated by Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomized controlled trials comparing duct-to-mucosa anastomosis vs. invagination anastomosis in pancreatic surgery were included.Result: Seven studies involving 1,110 participants were included. Using the postoperative pancreatic fistula definition provided by the International Study Group of Pancreatic Surgery 2016, the incidence rate of grade B/C pancreatic fistula was significantly lower in patients experiencing invagination anastomosis than in those undergoing duct-to-mucosa anastomosis. Four of seven trials comparing invagination with duct-to-mucosa anastomosis in patients with a soft pancreas showed that invagination was significantly better than duct-to-mucosa anastomosis in controlling pancreatic fistula formation, but no significant difference was detected between the two anastomosis techniques in patients with a hard pancreas. No significant difference in the length of hospital stay or postoperative mortality rate was found between the two methods.Conclusion: This study demonstrated superiority of invagination anastomosis over duct-to-mucosa anastomosis in reducing the risk of Grade B/C postoperative pancreatic fistula using the ISGPS 2016 definition, but it does not significantly reduce the mortality rate or length of hospital stay. The effect of invagination in reducing pancreatic fistula formation is obvious in patients with a soft pancreas, but there is no significant difference between the two anastomosis techniques in patients with a hard pancreas. We found a lower rate of clinically relevant postoperative pancreatic fistula in the invagination group, in patients with a soft pancreas.
Highlights
Different criteria of clinically relevant postoperative pancreatic fistula (POPF) result in the optimal anastomosis technique remaining controversial
The search strategy involved use of the following key terms: “duct-to-mucosa” “pancreatic fistula” “pancreaticoduodenectomy” and “invagination.” The search was limited to publications of randomized controlled trials (RCTs)
We found that patients with a soft pancreas were more likely to develop POPF after duct-to-mucosa than after invagination anastomosis
Summary
Different criteria of clinically relevant postoperative pancreatic fistula (POPF) result in the optimal anastomosis technique remaining controversial. PD is the most common treatment method for patients with a resectable tumor of the pancreatic head and periampullary region or a suspicious mass or nodule in that area with obvious clinical manifestations. The use of more anastomoses in abdominal surgery increases the risk of developing a postoperative fistula, which may result in various postoperative complications. A postoperative pancreatic fistula (POPF) remains one of the most common complications of PD and can lead to abdominal infection, bleeding, and sepsis, all of which lead to a longer postoperative hospital stay, severe and potentially fatal complications, and higher mortality [1]. Pancreaticojejunostomy and pancreaticogastrostomy are two common methods for digestive reconstruction after PD. Ductto-mucosa anastomosis and invagination anastomosis are the two major pancreaticojejunostomy techniques, which can be applied to pancreaticogastrostomy
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