The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy.

Abstract

Postoperative pancreatic fistula (POPF) remains a major cause of morbidity following pancreaticoduodenectomy (PD). This network meta-analysis (NMA) compared techniques of pancreatic anastomosis following PD to determine the technique with the best outcome profile. A systematic literature search was performed on the Scopus, EMBASE, Medline and Cochrane databases to identify RCTs employing the international study group of pancreatic fistulas (ISGPF) definition of POPF. The main outcomes were POPF and clinically relevant POPF. Three techniques of pancreatic anastomosis following PD were directly compared in 16 RCTs comprising 2365 patients. Overall, 929 patients underwent duct-to-mucosa pancreaticojejunostomy (PJ DTM), 760 patients' invagination pancreaticojejunostomy (PJ Inv), and 676 patients underwent pancreatogastrostomy (PG). The results of comparisons of POPF, clinically relevant POPF, biliary leakage, delayed gastric emptying (DGE), in hospital mortality, internal hemorrhage, reoperation in our network meta-analysis suggested there were no significant differences among the 3 procedures. There are no significant differences among PJ DTM, PJ Inv and PG in the prevention of POPF, clinically relevant POPF, biliary leakage, DGE, internal hemorrhage and reoperation. However, further randomized controlled trials should be undertaken to ascertain these findings.