title: Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy.
abstract: OBJECTIVE
  To investigate the differences in outcome following pylorus preserving pancreaticoduodenectomy (PPPD) and subtotal stomach-preserving pancreaticoduodenectomy (SSPPD).
  
  
  METHODS
  Major databases including PubMed (Medline), EMBASE and Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched for comparative studies between patients with PPPD and SSPPD published between January 1978 and July 2014. Studies were selected based on speciﬁc inclusion and exclusion criteria. The primary outcome was delayed gastric emptying (DGE). Secondary outcomes included operation time, intraoperative blood loss, pancreatic fistula, postoperative hemorrhage, intraabdominal abscess, wound infection, time to starting liquid diet, time to starting solid diet, period of nasogastric intubation, reinsertion of nasogastric tube, mortality and hospital stay. The pooled odds ratios (OR) or weighted mean difference (WMD) with 95% confidence intervals (95%CI) were calculated using either a fixed-effects or random-effects model.
  
  
  RESULTS
  Eight comparative studies recruiting 650 patients were analyzed, which include two RCTs, one non-randomized prospective and 5 retrospective trial designs. Patients undergoing SSPPD experienced significantly lower rates of DGE (OR = 2.75; 95%CI: 1.75-4.30, P < 0.00001) and a shorter period of nasogastric intubation (OR = 2.68; 95%CI: 0.77-4.58, P < 0.00001), with a tendency towards shorter time to liquid (WMD = 2.97, 95%CI: -0.46-7.83; P = 0.09) and solid diets (WMD = 3.69, 95%CI: -0.46-7.83; P = 0.08) as well as shorter inpatient stay (WMD = 3.92, 95%CI: -0.37-8.22; P = 0.07), although these latter three did not reach statistical significance. PPPD, however, was associated with less intraoperative blood loss than SSPPD [WMD = -217.70, 95%CI: -429.77-(-5.63); P = 0.04]. There were no differences in other parameters between the two approaches, including operative time (WMD = -5.30, 95%CI: -43.44-32.84; P = 0.79), pancreatic fistula (OR = 0.91; 95%CI: 0.56-1.49; P = 0.70), postoperative hemorrhage (OR = 0.51; 95%CI: 0.15-1.74; P = 0.29), intraabdominal abscess (OR = 1.05; 95%CI: 0.54-2.05; P = 0.89), wound infection (OR = 0.88; 95%CI: 0.39-1.97; P = 0.75), reinsertion of nasogastric tube (OR = 1.90; 95%CI: 0.91-3.97; P = 0.09) and mortality (OR = 0.31; 95%CI: 0.05-2.01; P = 0.22).
  
  
  CONCLUSIONS
  SSPPD may improve intraoperative and short-term postoperative outcomes compared to PPPD, especially DGE. However, these findings need to be further ascertained by well-designed randomized controlled trials.
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Xiong
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Wan
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Peter
authors.initials: P
authors.lastname: Szatmary
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Shameena
authors.initials: S
authors.lastname: Bharucha
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ilias
authors.initials: I
authors.lastname: Gomatos
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Quentin M
authors.initials: QM
authors.lastname: Nunes
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xia
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.affiliation: Wei Huang, Mei-Hua Wan, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese Medicine and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Xu-Bao
authors.initials: XB
authors.lastname: Liu
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011708:Pylorus / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Delayed gastric emptying; Meta-analysis; Pancreatic surgery; Pancreaticoduodenectomy; Pylorus preserving Subtotal stomach preserving pancreaticoduodenectomy