The Safety and Efficacy of Roux-en-Y Reconstruction with Isolated Pancreaticojejunos-tomy after Pancreaticoduodenectomy: a Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DINGWei ,  TANYu-lin , WANGYi-bo , ZHUXiao-jun , XUYi-xin , XUXue-zhong

Department of Hepatobiliary Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou 213002, Jiangsu Province, China;

Corresponding author：

TANYu-lin, Email: tanyldoctor@163.com

Keywords：

ancreaticoduodenectomy; Reconstruction; Isolated pancreaticojejunostomy; Complication; Meta-analysis

DOI：

10.7507/1007-9424.20160215

Video：

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Objective To evaluate the safety and efficacy of Roux-en-Y reconstruction with isolated pancreatico-jejunostomy after pancreaticoduodenectomy. Methods Systematically literature search was performed through PubMed, EMBASE, Cochrane Library, Wanfang, VIP, and CNKI from the earliest to November 30, 2015. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing outcomes of Roux-en-Y reconstruction with isolated pancrea-ticojejunostomy and conventional pancreaticojejunostomy were searched. The data were applied meta-analysis by RevMan 5.3. Results Seven trials were involved, two RCTs including 367 patients and five CCTs including 431 patients. Meta-analysis result showed that there was no statistic significant difference in pancreas fistula between Roux-en-Y reconstruction with isolated pancreaticojejunostomy and conventional pancreaticojejunostomy. Conclusion Roux-en-Y reconstruction with isolated pancreaticojejunostomy after pancreaticoduodenectomy is not superior to conventional pancreaticojejunostomy regarding pancreatic fistula rate or other relevant outcomes.

Citation： DINGWei, TANYu-lin, WANGYi-bo, ZHUXiao-jun, XUYi-xin, XUXue-zhong. The Safety and Efficacy of Roux-en-Y Reconstruction with Isolated Pancreaticojejunos-tomy after Pancreaticoduodenectomy: a Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(7): 822-832. doi: 10.7507/1007-9424.20160215 Copy

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2.	Chen JY, Feng J, Wang XQ, et al. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenec-tomy. World J Gastroenterol, 2015, 21(19): 5926-5933.
3.	Watanabe F, Noda H, Kamiyama H, et al. Risk factors for intra-abdo-minal infection after pancreaticoduodenectomy-a retrospective analysis to evaluate the significance of preoperative biliary drainage and postoperative pancreatic fistula. Hepatogastroenterology, 2012, 59(116): 1270-1273.
4.	Harnoss JC, Ulrich AB, Harnoss JM, et al. Use and results of conse-nsus definitions in pancreatic surgery: a systematic review. Surgery, 2014, 155(1): 47-57.
5.	Chen YJ, Lai EC, Lau WY, et al. Enteric reconstruction of pancreatic stump following pancreaticoduodenectomy: a review of the litera-ture. Int J Surg, 2014, 12(7): 706-711.
6.	Matsuda M, Haruta S, Shinohara H, et al. Pancreaticogastrostomy in pure laparoscopic pancreaticoduodenectomy-A novel pancreatic-gastric anastomosis technique. BMC Surg, 2015, 15: 80.
7.	Hackert T, Büchler MW. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenec-tomy. Br J Surg, 2014, 101(9): 1084-1091.
8.	Uzunoglu FG, Reeh M, Wollstein R, et al. Single versus double Roux-en-Y reconstruction techniques in pancreaticoduodenectomy: a comparative single-center study. World J Surg, 2014, 38(12): 3228-3234.
9.	Lei P, Fang J, Huang Y, et al. Pancreaticogastrostomy or pancreatico-jejunostomy? Methods of digestive continuity reconstruction after pancreaticodudenectomy: a meta-analysis of randomized controlled trials. Int J Surg, 2014, 12(12): 1444-1449.
10.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
11.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
12.	Ballas K, Symeonidis N, Rafailidis S, et al. Use of isolated Roux loop for pancreaticojejunostomy reconstruction after pancreaticoduo-denectomy. World J Gastroenterol, 2010, 16(25): 3178-3182.
13.	Casadei R, Zanini N, Pezzilli R, et al. Reconstruction after pancrea-ticoduodenectomy: isolated Roux loop pancreatic anastomosis. Chir Ital, 2008, 60(5): 641-649.
14.	Kaman L, Sanyal S, Behera A, et al. Isolated roux loop pancreaticoje-junostomy vs single loop pancreaticojejunostomy after pancreati-coduodenectomy. Int J Surg, 2008, 6(4): 306-310.
15.	Ke S, Ding XM, Gao J, et al. A prospective, randomized trial of Roux-en-Y reconstruction with isolated pancreatic drainage versus conventional loop reconstruction after pancreaticoduodenectomy. Surgery, 2013, 153(6): 743-752.
16.	Li DB, Chai C, Cao L, et al. Isolated Roux-en-Y reconstruction versus conventional reconstruction after pancreaticoduodenectomy. Surgeon,.
17.	Aug 14. pii: S1479-666X(15)00077-3.
18.	Perwaiz A, Singhal D, Singh A, et al. Is isolated Roux loop pancrea-ticojejunostomy superior to conventional reconstruction in pancrea-ticoduodenectomy? HPB (Oxford), 2009, 11(4): 326-331.
19.	Tani M, Kawai M, Hirono S, et al. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancrea-ticoduodenectomy. Br J Surg, 2014, 101(9): 1084-1091.
20.	Song J, Liu H, Li Z, et al. Long-term prognosis of surgical treatment for early ampullary cancers and implications for local ampullectomy. BMC Surg, 2015, 15: 32-38.
21.	Kiyochi H, Matsukage S, Nakamura T, et al. Pathologic assessment of pancreatic fibrosis for objective prediction of pancreatic fistula and management of prophylactic drain removal after pancreatico-duodenectomy. World J Surg, 2015, 39(12): 2967-2974.
22.	窦科峰, 彭伟.胰十二指肠切除后胰肠吻合的相关问题.中华普通外科杂志, 2015, 30(5): 337-339.
23.	Kingsnorth AN. Safety and function of isolated Roux loop pancrea-ticojejunostomy after Whipple's pancreaticoduodenectomy. Ann R Coll Surg Engl, 1994, 76(3): 175-179.
24.	Sutton CD, Garcea G, White SA, et al. Isolated Roux-loop pancrea-ticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks. J Gastrointest Surg, 2004, 8(6): 701-705.
25.	Diener MK, Simon T, Büchler MW, et al. Surgical evaluation and knowledge transfer-methods of clinical research in surgery. Langenbecks Arch Surg, 2012, 397(8): 1193-1199.
26.	Doerr-Harim C, Bruckner T, Diener MK, et al. Insights into surgical trials: methodological challenges and solutions. Langenbecks Arch Surg, 2014, 399(3): 273-278.

1. Mohammed S, Van Buren G 2nd, Fisher WE. Pancreatic cancer advances in treatment. World J Gastroenterol, 2014, 20(28): 9354-9360.
2. Chen JY, Feng J, Wang XQ, et al. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenec-tomy. World J Gastroenterol, 2015, 21(19): 5926-5933.
3. Watanabe F, Noda H, Kamiyama H, et al. Risk factors for intra-abdo-minal infection after pancreaticoduodenectomy-a retrospective analysis to evaluate the significance of preoperative biliary drainage and postoperative pancreatic fistula. Hepatogastroenterology, 2012, 59(116): 1270-1273.
4. Harnoss JC, Ulrich AB, Harnoss JM, et al. Use and results of conse-nsus definitions in pancreatic surgery: a systematic review. Surgery, 2014, 155(1): 47-57.
5. Chen YJ, Lai EC, Lau WY, et al. Enteric reconstruction of pancreatic stump following pancreaticoduodenectomy: a review of the litera-ture. Int J Surg, 2014, 12(7): 706-711.
6. Matsuda M, Haruta S, Shinohara H, et al. Pancreaticogastrostomy in pure laparoscopic pancreaticoduodenectomy-A novel pancreatic-gastric anastomosis technique. BMC Surg, 2015, 15: 80.
7. Hackert T, Büchler MW. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenec-tomy. Br J Surg, 2014, 101(9): 1084-1091.
8. Uzunoglu FG, Reeh M, Wollstein R, et al. Single versus double Roux-en-Y reconstruction techniques in pancreaticoduodenectomy: a comparative single-center study. World J Surg, 2014, 38(12): 3228-3234.
9. Lei P, Fang J, Huang Y, et al. Pancreaticogastrostomy or pancreatico-jejunostomy? Methods of digestive continuity reconstruction after pancreaticodudenectomy: a meta-analysis of randomized controlled trials. Int J Surg, 2014, 12(12): 1444-1449.
10. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
11. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
12. Ballas K, Symeonidis N, Rafailidis S, et al. Use of isolated Roux loop for pancreaticojejunostomy reconstruction after pancreaticoduo-denectomy. World J Gastroenterol, 2010, 16(25): 3178-3182.
13. Casadei R, Zanini N, Pezzilli R, et al. Reconstruction after pancrea-ticoduodenectomy: isolated Roux loop pancreatic anastomosis. Chir Ital, 2008, 60(5): 641-649.
14. Kaman L, Sanyal S, Behera A, et al. Isolated roux loop pancreaticoje-junostomy vs single loop pancreaticojejunostomy after pancreati-coduodenectomy. Int J Surg, 2008, 6(4): 306-310.
15. Ke S, Ding XM, Gao J, et al. A prospective, randomized trial of Roux-en-Y reconstruction with isolated pancreatic drainage versus conventional loop reconstruction after pancreaticoduodenectomy. Surgery, 2013, 153(6): 743-752.
16. Li DB, Chai C, Cao L, et al. Isolated Roux-en-Y reconstruction versus conventional reconstruction after pancreaticoduodenectomy. Surgeon,.
17. Aug 14. pii: S1479-666X(15)00077-3.
18. Perwaiz A, Singhal D, Singh A, et al. Is isolated Roux loop pancrea-ticojejunostomy superior to conventional reconstruction in pancrea-ticoduodenectomy? HPB (Oxford), 2009, 11(4): 326-331.
19. Tani M, Kawai M, Hirono S, et al. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancrea-ticoduodenectomy. Br J Surg, 2014, 101(9): 1084-1091.
20. Song J, Liu H, Li Z, et al. Long-term prognosis of surgical treatment for early ampullary cancers and implications for local ampullectomy. BMC Surg, 2015, 15: 32-38.
21. Kiyochi H, Matsukage S, Nakamura T, et al. Pathologic assessment of pancreatic fibrosis for objective prediction of pancreatic fistula and management of prophylactic drain removal after pancreatico-duodenectomy. World J Surg, 2015, 39(12): 2967-2974.
22. 窦科峰, 彭伟.胰十二指肠切除后胰肠吻合的相关问题.中华普通外科杂志, 2015, 30(5): 337-339.
23. Kingsnorth AN. Safety and function of isolated Roux loop pancrea-ticojejunostomy after Whipple's pancreaticoduodenectomy. Ann R Coll Surg Engl, 1994, 76(3): 175-179.
24. Sutton CD, Garcea G, White SA, et al. Isolated Roux-loop pancrea-ticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks. J Gastrointest Surg, 2004, 8(6): 701-705.
25. Diener MK, Simon T, Büchler MW, et al. Surgical evaluation and knowledge transfer-methods of clinical research in surgery. Langenbecks Arch Surg, 2012, 397(8): 1193-1199.
26. Doerr-Harim C, Bruckner T, Diener MK, et al. Insights into surgical trials: methodological challenges and solutions. Langenbecks Arch Surg, 2014, 399(3): 273-278.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Safety and Efficacy of Roux-en-Y Reconstruction with Isolated Pancreaticojejunos-tomy after Pancreaticoduodenectomy: a Meta-Analysis

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