Abstract
BackgroundThe aim of this meta-analysis was to compare the long-term survival, mortality, morbidity and the operation-related events in patients with periampullary and pancreatic carcinoma undergoing pylorus-preserving pancreaticoduodenectomy (PPPD) and pylorus-resecting pancreaticoduodenectomy (PRPD).MethodA systematic search of literature databases (Cochrane Library, PubMed, EMBASE and Web of Science) was performed to identify studies. Outcome measures comparing PPPD versus PRPD for periampullary and pancreatic carcinoma were long-term survival, mortality, morbidity (overall morbidity, delayed gastric emptying [DGE], pancreatic fistula, wound infection, postoperative bleeding, biliary leakage, ascites and gastroenterostomy leakage) and operation related events (hospital stays, operating time, intraoperative blood loss and red blood cell transfusions).ResultsEight randomized controlled trials (RCTs) including 622 patients were identified and included in the analysis. Among these patients, it revealed no difference in long-term survival between the PPPD and PRPD groups (HR = 0.23, p = 0.11). There was a lower rate of DGE (RR = 2.35, p = 0.04, 95% CI, 1.06–5.21) with PRPD. Mortality, overall morbidity, pancreatic fistula, wound infection, postoperative bleeding, biliary leakage, ascites and gastroenterostomy leakage were not significantly different between the groups. PPPDs were performed more quickly than PRPDs (WMD = 53.25 minutes, p = 0.01, 95% CI, 12.53–93.97); and there was less estimated intraoperative blood loss (WMD = 365.21 ml, p = 0.006, 95% CI, 102.71–627.71) and fewer red blood cell transfusions (WMD = 0.29 U, p = 0.003, 95% CI, 0.10–0.48) in patients undergoing PPPD. The hospital stays showed no significant difference.ConclusionsPPPD had advantages over PRPD in operating time, intraoperative blood loss and red blood cell transfusions, but had a significantly higher rate of DGE for periampullary and pancreatic carcinoma. PPPD and PRPD had comparable mortality and morbidity including pancreatic fistulas, wound infections, postoperative bleeding, biliary leakage, ascites and gastroenterostomy leakage. Our conclusions were limited by the available data. Further evaluations of high-quality RCTs are needed.
Highlights
Pancreatic carcinoma is the fourth most common malignancy and is associated with an extremely poor prognosis, reflected by a median survival of,6 months and a 5-year survival of,5% [1,2]
pylorus-resecting pancreaticoduodenectomy (PRPD) has been advocated because peripyloric lymph nodes can be adequately dissected under direct vision and a safe surgical margin is easy to achieve during the operation, with the intent to decrease the risk of tumor recurrence and to prolong survival [6]
Some clinical controlled trials have demonstrated the superiority of pylorus-preserving pancreaticoduodenectomy (PPPD) to PRPD, other researchers have reported that PPPD and PRPD were effective in terms of postoperative complications, mortality, and long-term survival [8,9]
Summary
Pancreatic carcinoma is the fourth most common malignancy and is associated with an extremely poor prognosis, reflected by a median survival of ,6 months and a 5-year survival of ,5% [1,2]. Surgical resection provides the only hope of a cure for periampullary and pancreatic carcinoma, whereas high rates of postoperative complications remain significant causes of mortality and markedly prolonged hospitalizations [3]. Pancreaticoduodenectomy (PD) is the primary surgical treatment for patients with periampullary and pancreatic carcinoma. The pylorus-resecting PD (PRPD) operation involves removing the pancreatic head, duodenum, common bile duct, gall bladder with (or without) the distal portion of the stomach associated with the adjacent lymph nodes [4]. Certain authors have argued that the PRPD technique does not increase postoperative morbidity and mortality [14] The aim of this meta-analysis was to compare the long-term survival, mortality, morbidity and the operationrelated events in patients with periampullary and pancreatic carcinoma undergoing pylorus-preserving pancreaticoduodenectomy (PPPD) and pylorus-resecting pancreaticoduodenectomy (PRPD)
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