title: Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-Analysis.
abstract: BACKGROUND
  The reconstruction of the pancreas after pancreaticoduodenectomy (PD) is a crucial factor in preventing postoperative complications as pancreatic anastomosis failure is associated with a high morbidity rate and contributes to prolonged hospitalization and mortality. Several techniques have been described for the reconstruction of pancreatic digestive continuity in the attempt to minimize the risk of a pancreatic fistula. The aim of this study was to compare the results of pancreaticogastrostomy and pancreaticojejunostomy after PD.
  
  
  METHODS
  A systematic review and meta-analysis were conducted of randomized controlled trials (RCTs) published up to January 2015 comparing patients with pancreaticogastrostomy (PG group) versus pancreaticojejunostomy (PJ group). Two reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model.
  
  
  RESULTS
  Eight RCTs describing 1,211 patients were identified for inclusion in the study. The meta-analysis shows that the PG group had a significantly lower incidence rate of postoperative pancreatic fistulas [OR 0.64 (95% confidence interval 0.46-0.86), p = .003], intra-abdominal abscesses [OR 0.53 (95% CI, 0.33-0.85), p = .009] and length of hospital stay [MD -1.62; (95% CI 2.63-0.61), p = .002] than the PJ group, while biliary fistula, mortality, morbidity, rate of delayed gastric emptying, reoperation, and bleeding did not differ between the two groups.
  
  
  CONCLUSIONS
  This meta-analysis suggests that the most effective treatment for reconstruction of pancreatic continuity after pancreatoduodenectomy is pancreaticogastrostomy. However, the advantage of the latter could potentially be demonstrated through further RCTs, including only patients at high risk of developing pancreatic fistulas.
authors.affiliation: a Ravenna Hospital, AUSL Romagna , HBP and General Surgery Unit , Ravenna , Italy.
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Guerrini
authors.affiliation: a Ravenna Hospital, AUSL Romagna , HBP and General Surgery Unit , Ravenna , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Soliani
authors.affiliation: b Papa Giovanni XXIII Hospital and Milan University , Department of Surgery and Transplantation , Bergamo , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Amico
authors.affiliation: c Policlinico Hospital, HPB and Liver Transplant Unit , University of Modena and Reggio Emilia , Modena , Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.affiliation: a Ravenna Hospital, AUSL Romagna , HBP and General Surgery Unit , Ravenna , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Negri
authors.affiliation: d Civile S. Agostino Estense Hospital , AUSL Modena, Robotic and General Surgery Unit , Modena , Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Piccoli
authors.affiliation: e "Sacro Cuore-Don Calabria" Hospital , General Surgery Unit , Negrar (Verona) , Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Ruffo
authors.affiliation: f Royal Free Hospital, HPB & Liver Transplant Unit , University College Medical School of London , London , England.
authors.forename: Rafael Jose
authors.initials: RJ
authors.lastname: Orti-Rodriguez
authors.affiliation: f Royal Free Hospital, HPB & Liver Transplant Unit , University College Medical School of London , London , England.
authors.forename: Theodora
authors.initials: T
authors.lastname: Pissanou
authors.affiliation: f Royal Free Hospital, HPB & Liver Transplant Unit , University College Medical School of London , London , England.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fusai
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D010179:Pancreas / Q000601:surgery*; D010182:Pancreatic Diseases / Q000601:surgery; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome
keywords: meta-analysis; pancreatic cancer; pancreatic surgery; pancreaticoduodenectomy; pancreaticogastrostomy; pancreaticojejunostomy