title: Meta-analysis of pancreaticoduodenectomy prospective controlled trials: pancreaticogastrostomy versus pancreaticojejunostomy reconstruction.
abstract: BACKGROUND
  Pancreaticogastrostomy (PG) has been proposed as an alternative to pancreaticojejunostomy (PJ), assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.
  
  
  METHODS
  Articles of prospective controlled trials published until the end of December 2010 comparing PJ and PG after PD were searched by means of MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and Chinese Biomedical Database. After quality assessment of all included prospective controlled trials, meta-analysis was performed with Review Manager 5.0 for statistic analysis.
  
  
  RESULTS
  Overall, six articles of prospective controlled trials were included. Of the 866 patients analyzed, 440 received PG and 426 were treated by PJ. Meta-analysis of six prospective controlled trials (including RCT and non-randomized prospective trial) revealed significant difference between PJ and PG regarding postoperative complication rates (OR, 0.53; 95%CI, 0.30 - 0.95; P = 0.03), pancreatic fistula (OR, 0.47; 95%CI, 0.22 - 0.97; P = 0.04), and intra-abdominal fluid collection (OR, 0.42; 95%CI, 0.25 - 0.72; P = 0.001). The difference in mortality was of no significance. Meta-analysis of four randomized controlled trials (RCT) revealed significant difference between PJ and PG regarding intra-abdominal fluid collection (OR, 0.46; 95% CI, 0.26 - 0.79; P = 0.005). The differences in pancreatic fistula, postoperative complications, delayed gastric emptying, and mortality were of no significance.
  
  
  CONCLUSIONS
  Meta-analysis of six prospective controlled trials (including randomized controlled trials (RCT) and non-randomized prospective trial) revealed significant difference between PJ and PG regarding overall postoperative complications, pancreatic fistula, and intra-abdominal fluid collection. Meta-analysis of four RCT revealed significant difference between PJ and PG with regard to intra-abdominal fluid collection. The results suggest that PG may be as safe as PJ.
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
authors.forename: Jin-Ping
authors.initials: JP
authors.lastname: Ma
authors.forename: Lin
authors.initials: L
authors.lastname: Peng
authors.forename: Tao
authors.initials: T
authors.lastname: Qin
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Chuang-Qi
authors.initials: CQ
authors.lastname: Chen
authors.forename: Shi-Rong
authors.initials: SR
authors.lastname: Cai
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: He
mesh_terms: D005260:Female; D005746:Gastric Emptying; D005774:Gastrostomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic