A case-matched comparison and meta-analysis comparing pylorus-resecting pancreaticoduodenectomy with pylorus-preserving pancreaticoduodenectomy for the incidence of postoperative delayed gastric emptying.
OBJECTIVE
This study was conducted to compare the incidences of delayed gastric emptying (DGE) following pylorus-resecting pancreaticoduodenectomy (PrPD) and pylorus-preserving pancreaticoduodenectomy (PpPD), respectively.


METHODS
Data for 37 patients submitted to PrPD were compared with data for a matched number of patients submitted to PpPD during the same period. A meta-analysis of comparative studies of the two techniques was also carried out. The primary endpoint was the rate of DGE (grades A-C) defined according to the International Study Group of Pancreatic Surgery criteria.


RESULTS
In the case-matched comparison, both overall DGE (six PrPD patients and 17 PpPD patients; P = 0.006) and clinically relevant DGE (one PrPD and eight PpPD patients; P = 0.013) occurred significantly less often in the PrPD group than in the PpPD group. Based on eight non-randomized clinical trials and two randomized clinical trials involving 804 subjects, the meta-analysis further confirmed a significant reduction in DGE with pooled odds ratios of 0.33 [95% confidence interval (CI) 0.17-0.63; P < 0.001] and 0.13 (95% CI 0.05-0.40; P < 0.001) for overall DGE and clinically relevant DGE, respectively. Other complications and mortality were similar in both groups.


CONCLUSIONS
Pylorus-resecting pancreaticoduodenectomy is a safe procedure associated with less severe and less frequent postoperative DGE than PpPD.
Department of Hepato-Biliary-Pancreato-Vascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
Yanming
Y
Zhou
Liang
L
Lin
Lupeng
L
Wu
Donghui
D
Xu
Bin
B
Li
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D018589:Gastroparesis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016017:Odds Ratio; D059351:Organ Sparing Treatments; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011708:Pylorus / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome