Surgical treatment strategies in chronic pancreatitis: a meta-analysis.
OBJECTIVE
To research the optimal surgical strategy for chronic pancreatitis.


METHODS
PubMed, EMBASE, Science Citation Index, SpringerLink, and secondary sources from inception through December 31, 2011, with no restrictions on languages or regions.


METHODS
All controlled experimental (randomized and nonrandomized) studies in which duodenum-preserving pancreatic head resection was compared with pancreaticoduodenectomy in chronic pancreatitis.


METHODS
Data were extracted independently and in duplicate by 2 reviewers; discrepancies were resolved by discussion.


RESULTS
A total of 1007 patients from 15 studies were included in the meta-analysis. The relative risks for postoperative pain relief and postoperative morbidity in the Beger procedure were 1.29 (95% CI, 1.03-1.61; P = .03) and 0.55 (0.21-1.39; P = .20), respectively, compared with pancreaticoduodenectomy. These results are just the opposite in the Frey procedure, in which a significantly better outcome was shown in postoperative morbidity compared with resection (relative risk, 0.60; 95% CI, 0.46-0.78; P < .01) but not in postoperative pain relief (1.03; 0.90-1.17; P = .67). In terms of quality of life, pancreatic exocrine function, and delayed gastric emptying, the results also favored duodenum-preserving strategies.


CONCLUSIONS
For the duodenum-preserving strategy of the Beger procedure, complete pain relief is achieved in most patients, but there is no evidence that it has a better result in postoperative morbidity. For the Frey procedure, a significantly lower postoperative morbidity is demonstrated, but complete pain relief is not provided in most cases. Thus, compared with conventional pancreaticoduodenectomy, both new strategies should be recommended on the basis of the patients' appropriate individual preferences.
Cancer Research Centre.
Zi
Z
Yin
Jian
J
Sun
Dong
D
Yin
Jie
J
Wang
D004322:Drainage / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D059408:Pain Management; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D010179:Pancreas / Q000601:surgery; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D016577:Pancreaticoduodenectomy / Q000706:statistics & numerical data*; D050500:Pancreatitis, Chronic / Q000453:epidemiology / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome