Weidong Wang1, Zhaohui Zhang2, Chichang Gu1, Qingbo Liu2, Zhiqiang Liang1, Wei He1, Jianping Chen1, Jiaming Lai3. 1. Second Department of General Surgery, Shunde Hospital, Southern Medical University, China. 2. Department of Pancreatico-Biliary Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China. 3. Department of Pancreatico-Biliary Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China. Electronic address: jmlai2000@aliyun.com.
Abstract
BACKGROUND: A number of pancreatic anastomosis methods for pancreaticoduodenectomy including pancreaticogastrostomy(PG), duct-to-mucosa pancreaticojejunostomy(duct-to-mucosa PJ), invagination pancreaticojejunostomy(invagination PJ) and binding pancreaticojejunostomy(BPJ), but the optimal choice remains unclear. We performed a network meta-analysis to synthesize direct and indirect evidence to identify the optimal choice for pancreatic anastomosis after pancreaticoduodenectomy METHODS: We searched the Embase, PubMed and Cochrane library databases for randomized control trials. The relative risk (RR) and its 95% confidence interval (CI) were calculated. The primary outcome is postoperative pancreatic fistula (POPF). RESULT: In total, 16 RCT studies, including a total of 2396 patients, met our criteria. The results showed that PG is not superior to invagination PJ (RR 0.70 95%CI: 0.35-1.39) and duct-to-mucosa PJ (RR 0.58 95%CI: 0.30-1.10) according to the ISGPS definition. Furthermore PG cannot reduce the POPF rates than invagination PJ (RR 0.51 95%CI: 0.2-1.21) and duct-to-mucosa PJ (RR 0.46 95%CI: 0.16-1.14) according to the soft pancreatic texture. BPJ might reduce the incidence of POPF than duct-to-mucosa PJ (RR 0.00 95%CI: 0.00-0.04), invagination PJ (RR 0.00 95%CI: 0.00-0.03), PG (RR 0.00 95%CI: 0.00-0.03), but the results have major limitations with only one RCT reported BPJ and different definition of POPF. CONCLUSION: There are no significant differences among BPJ, duct-to-mucosa PJ, invagination PJ and PG in the prevention of POPF, overall morbidity, mortality and DGE. However, further randomized controlled trials should be undertaken to ascertain these findings, especially for BPJ.
BACKGROUND: A number of pancreatic anastomosis methods for pancreaticoduodenectomy including pancreaticogastrostomy(PG), duct-to-mucosa pancreaticojejunostomy(duct-to-mucosa PJ), invagination pancreaticojejunostomy(invagination PJ) and binding pancreaticojejunostomy(BPJ), but the optimal choice remains unclear. We performed a network meta-analysis to synthesize direct and indirect evidence to identify the optimal choice for pancreatic anastomosis after pancreaticoduodenectomy METHODS: We searched the Embase, PubMed and Cochrane library databases for randomized control trials. The relative risk (RR) and its 95% confidence interval (CI) were calculated. The primary outcome is postoperative pancreatic fistula (POPF). RESULT: In total, 16 RCT studies, including a total of 2396 patients, met our criteria. The results showed that PG is not superior to invagination PJ (RR 0.70 95%CI: 0.35-1.39) and duct-to-mucosa PJ (RR 0.58 95%CI: 0.30-1.10) according to the ISGPS definition. Furthermore PG cannot reduce the POPF rates than invagination PJ (RR 0.51 95%CI: 0.2-1.21) and duct-to-mucosa PJ (RR 0.46 95%CI: 0.16-1.14) according to the soft pancreatic texture. BPJ might reduce the incidence of POPF than duct-to-mucosa PJ (RR 0.00 95%CI: 0.00-0.04), invagination PJ (RR 0.00 95%CI: 0.00-0.03), PG (RR 0.00 95%CI: 0.00-0.03), but the results have major limitations with only one RCT reported BPJ and different definition of POPF. CONCLUSION: There are no significant differences among BPJ, duct-to-mucosa PJ, invagination PJ and PG in the prevention of POPF, overall morbidity, mortality and DGE. However, further randomized controlled trials should be undertaken to ascertain these findings, especially for BPJ.
Authors: Vincenzo Mazzaferro; Matteo Virdis; Carlo Sposito; Christian Cotsoglou; Michele Droz Dit Busset; Marco Bongini; Maria Flores; Natalie Prinzi; Jorgelina Coppa Journal: Ann Surg Date: 2019-11 Impact factor: 12.969
Authors: Ramiro Fernandez-Placencia; Francisco Berrospi-Espinoza; Karla Uribe-Rivera; Jose Medina-Cana; Ivan Chavez-Passiuri; Nestor Sanchez-Bartra; Kori Paredes-Galvez; Carlos Luque-Vasquez Vasquez; Juan Celis-Zapata; Eloy Ruiz-Figueroa Journal: Surg Res Pract Date: 2021-02-27
Authors: Kit-Fai Lee; Kandy Kam Cheung Wong; Eugene Yee Juen Lo; Janet Wui Cheung Kung; Hon-Ting Lok; Charing Ching Ning Chong; John Wong; Paul Bo San Lai; Kelvin Kwok Chai Ng Journal: Ann Hepatobiliary Pancreat Surg Date: 2022-02-28