Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy.
BACKGROUND
Pancreaticoduodenectomy is the primary treatment for periampullary cancer. Associated morbidity is high and often related to pancreatic anastomotic failure. This paper compares rates of pancreatic fistula, morbidity and mortality after pancreaticoduodenectomy in patients having reconstruction by pancreaticogastrostomy with those in patients having reconstruction by pancreaticojejunostomy.


METHODS
A meta-analysis was performed of all large cohort and randomized controlled trials carried out since 1990.


RESULTS
Eleven articles were identified for inclusion: one prospective randomized trial, two non-randomized prospective trials and eight observational cohort studies. The meta-analysis revealed a higher rate of pancreatic fistula associated with pancreaticojejunostomy reconstruction (relative risk (RR) 2.62 (95 per cent confidence interval (c.i.) 1.91 to 3.60)). A higher overall morbidity rate was also demonstrated in this group (RR 1.43 (95 per cent c.i. 1.26 to 1.61)), as was a higher mortality rate (RR 2.51 (95 per cent c.i. 1.61 to 3.91)).


CONCLUSIONS
Current literature suggests that the safer means of pancreatic reconstruction after pancreaticoduodenectomy is pancreaticogastrostomy, but much of the evidence comes from observational cohort study data.
McKay
A
A
Department of Surgery, University of Calgary, Calgary, Canada.
Mackenzie
S
S
Sutherland
F R
FR
Bathe
O F
OF
Doig
C
C
Dort
J
J
Vollmer
C M
CM
Dixon
E
E
D014670:Ampulla of Vater / Q000601:surgery; D015331:Cohort Studies; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors