A Meta-Analysis of Pancreaticojejunostomy on Postoperative Outcomes Following Pan-creaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HUANGMing-quan , CHENYang , WANGLi ,  TIANBo-le

Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

TIANBo-le, Email: bo-le@medmail.com.cn

Keywords：

Pancreaticoduodenectomy; pancreaticojejunostomy; pancreatic fistula; Meta-analysis

DOI：

10.7507/1007-9424.20160321

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effects of duct-to-mucosa pancreaticojejunostomy (dmPJ) and invagination pancreaticojejunostomy (iPJ) during pancreaticoduodenectomy (PD) on postoperative outcomes. Methods Pubmed, The Cochrane Library, Embase, Wanfang and CNKI database were searched to identify randomized controlled trials (RCTs) evaluating different type of pancreaticojejunostomy during PD. The literatures were screened according to inclusion and exclusion criteria. Quality assessment was conducted according to Jadad scoring system. Results Nine RCTs were included, 1 032 patients were recruited, including 510 patients in dmPJ group and 522 patients in iPJ group. Meta-analysis indicated that there were no significant differences between two groups in terms of the incidence of pancreatic fistula in total (OR=0.95, P=0.78), clinical relevant pancreatic fistula (OR=0.78, P=0.71), overall morbidity (OR=0.93, P=0.60), perioperative mortality (OR=0.86, P=0.71), reoperation rate (OR=1.18, P=0.59), and length of hospital stay (WMD=-1.11, P=0.19). Conclusion DmPJ and iPJ are comparable in terms of pancreatic fistula and other complications.

Citation： HUANG Ming-quan, CHEN Yang, WANG Li, TIAN Bo-le. A Meta-Analysis of Pancreaticojejunostomy on Postoperative Outcomes Following Pan-creaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(10): 1253-1258. doi: 10.7507/1007-9424.20160321 Copy

1.	Kennedy EP, Yeo CJ. Dunking pancreaticojejunostomy versus duct-to-mucosa anastomosis. J Hepatobiliary Pancreat Sci, 2011, 18(6):769-774.
2.	Hashimoto Y, Traverso LW. Incidence of pancreatic anastomotic failure and delayed gastric emptying after pancreatoduodenectomy in 507 consecutive patients:use of a web-based calculator to improve homogeneity of definition. Surgery, 2010, 147(4):503-515.
3.	Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg, 2015, 220(4):530-536.
4.	Zhang L, Li Z, Wu X, et al. Sealing pancreaticojejunostomy in combination with duct parenchyma to mucosa seromuscular one-layer anastomosis:a novel technique to prevent pancreatic fistula after pancreaticoduodenectomy. J Am Coll Surge, 2015, 220(5):e71-e77.
5.	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.
6.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (isgpf) definition. Surgery, 2005, 138(1):8-13.
7.	Bai X, Zhang Q, Gao S, et al. Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy:a prospective, randomized controlled trial from a single surgeon. J Am Coll Surg, 2016, 222(1):10-18.
8.	Bassi C, Falconi M, Molinari E, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduo-denectomy:results of a prospective randomized trial. Surgery, 2003, 134(5):766-771.
9.	Berger AC, Howard TJ, Kennedy EP, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? a randomized, prospective, dual-institution trial. J Am Coll Surg, 2009, 208(5):738-747; discussion 747-749.
10.	Chou FF, Sheen-Chen SM, Chen YS, et al. Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. Eur J Surg, 1996, 152(6):477-481.
11.	Dong K, Xiong W, Yu XJ, et al. Clinical study on suspension pancreatic-duct-jejunum end-to-side continuous suture anastomosis in pancreaticoduodenectomy. Chin Med Sci J, 2013, 28(1):34-38.
12.	El Nakeeb A, El Hemaly M, Askr W, et al. Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy:a prospective randomized study. Int J Surg, 2015, 16(Pt A):1-6.
13.	Langrehr JM, Bahra M, Jacob D, et al. Prospective randomized comparison between a new mattress technique and cattell (duct-to-mucosa) pancreaticojejunostomy for pancreatic resection. World J Surg, 2005, 29(9):1111-1119, discussion 1120-1111.
14.	张宇,杨洪吉,邓小凡,等. 袖套式prolene线单层连续缝合在胰肠吻合中的应用. 中国普通外科杂志, 2015, 24(3):312-318.
15.	韩建明,王新波,全竹富,等. 胰十二指肠切除术后胰管空肠黏膜吻合对胰瘘发生率的影响. 医学研究生学报, 2009, 22(9):961-964.
16.	Bai XL, Zhang Q, Masood N, et al. Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy:a meta-analysis. Chin Med J (Engl), 2013, 126(22):4340-4347.
17.	Hosotani R, Doi R, Imamura M. Duct-to-mucosa pancreaticojejunostomy reduces the risk of pancreatic leakage after pancreatoduodenectomy. World J Surg, 2002, 26(1):99-104.
18.	Tsuji M, Kimura H, Konishi K, et al. Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy:historical study of 300 patients. Surgery, 1998, 123(6):617-621.
19.	Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1):1-14.
20.	Miller BC, Christein JD, Behrman SW, et al. A multi-institutional external validation of the fistula risk score for pancreatoduodenectomy. J Gastrointest Surg, 2014, 18(1):172-179; discussion 179-180.
21.	Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg, 1995, 221(6):635-645; discussion 645-648.
22.	Hua J, He Z, Qian D, et al. Duct-to-mucosa versus invagination pancreaticojejunostomy following pancreaticoduodenectomy:a systematic review and meta-analysis. J Gastrointest Surg, 2015, 19(10):1900-1909.
23.	Peng SY, Wang JW, Lau WY, et al. Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy:a prospective randomized trial. Ann Surg, 2007, 245(5):692-698.
24.	Maggiori L, Sauvanet A, Nagarajan G, et al. Binding versus conventional pancreaticojejunostomy after pancreaticoduodenectomy:a case-matched study. J Gastrointest Surg, 2010, 14(9):1395-1400.
25.	Waugh JM, Clagett OT. Resection of the duodenum and head of the pancreas for carcinoma; an analysis of thirty cases. Surgery, 1946, 20:224-232.
26.	Menahem B, Guittet L, Mulliri A, et al. Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy:an updated meta-analysis of randomized controlled trials. Ann Surg, 2015, 261(5):882-887.
27.	Rault A, SaCunha A, Klopfenstein D, et al. Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for longterm outcomes of pancreatic exocrine function. J Am Coll Surg, 2005, 201(2):239-244.

1. Kennedy EP, Yeo CJ. Dunking pancreaticojejunostomy versus duct-to-mucosa anastomosis. J Hepatobiliary Pancreat Sci, 2011, 18(6):769-774.
2. Hashimoto Y, Traverso LW. Incidence of pancreatic anastomotic failure and delayed gastric emptying after pancreatoduodenectomy in 507 consecutive patients:use of a web-based calculator to improve homogeneity of definition. Surgery, 2010, 147(4):503-515.
3. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg, 2015, 220(4):530-536.
4. Zhang L, Li Z, Wu X, et al. Sealing pancreaticojejunostomy in combination with duct parenchyma to mucosa seromuscular one-layer anastomosis:a novel technique to prevent pancreatic fistula after pancreaticoduodenectomy. J Am Coll Surge, 2015, 220(5):e71-e77.
5. 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.
6. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (isgpf) definition. Surgery, 2005, 138(1):8-13.
7. Bai X, Zhang Q, Gao S, et al. Duct-to-mucosa vs invagination for pancreaticojejunostomy after pancreaticoduodenectomy:a prospective, randomized controlled trial from a single surgeon. J Am Coll Surg, 2016, 222(1):10-18.
8. Bassi C, Falconi M, Molinari E, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduo-denectomy:results of a prospective randomized trial. Surgery, 2003, 134(5):766-771.
9. Berger AC, Howard TJ, Kennedy EP, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? a randomized, prospective, dual-institution trial. J Am Coll Surg, 2009, 208(5):738-747; discussion 747-749.
10. Chou FF, Sheen-Chen SM, Chen YS, et al. Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. Eur J Surg, 1996, 152(6):477-481.
11. Dong K, Xiong W, Yu XJ, et al. Clinical study on suspension pancreatic-duct-jejunum end-to-side continuous suture anastomosis in pancreaticoduodenectomy. Chin Med Sci J, 2013, 28(1):34-38.
12. El Nakeeb A, El Hemaly M, Askr W, et al. Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy:a prospective randomized study. Int J Surg, 2015, 16(Pt A):1-6.
13. Langrehr JM, Bahra M, Jacob D, et al. Prospective randomized comparison between a new mattress technique and cattell (duct-to-mucosa) pancreaticojejunostomy for pancreatic resection. World J Surg, 2005, 29(9):1111-1119, discussion 1120-1111.
14. 张宇,杨洪吉,邓小凡,等. 袖套式prolene线单层连续缝合在胰肠吻合中的应用. 中国普通外科杂志, 2015, 24(3):312-318.
15. 韩建明,王新波,全竹富,等. 胰十二指肠切除术后胰管空肠黏膜吻合对胰瘘发生率的影响. 医学研究生学报, 2009, 22(9):961-964.
16. Bai XL, Zhang Q, Masood N, et al. Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy:a meta-analysis. Chin Med J (Engl), 2013, 126(22):4340-4347.
17. Hosotani R, Doi R, Imamura M. Duct-to-mucosa pancreaticojejunostomy reduces the risk of pancreatic leakage after pancreatoduodenectomy. World J Surg, 2002, 26(1):99-104.
18. Tsuji M, Kimura H, Konishi K, et al. Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy:historical study of 300 patients. Surgery, 1998, 123(6):617-621.
19. Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1):1-14.
20. Miller BC, Christein JD, Behrman SW, et al. A multi-institutional external validation of the fistula risk score for pancreatoduodenectomy. J Gastrointest Surg, 2014, 18(1):172-179; discussion 179-180.
21. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg, 1995, 221(6):635-645; discussion 645-648.
22. Hua J, He Z, Qian D, et al. Duct-to-mucosa versus invagination pancreaticojejunostomy following pancreaticoduodenectomy:a systematic review and meta-analysis. J Gastrointest Surg, 2015, 19(10):1900-1909.
23. Peng SY, Wang JW, Lau WY, et al. Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy:a prospective randomized trial. Ann Surg, 2007, 245(5):692-698.
24. Maggiori L, Sauvanet A, Nagarajan G, et al. Binding versus conventional pancreaticojejunostomy after pancreaticoduodenectomy:a case-matched study. J Gastrointest Surg, 2010, 14(9):1395-1400.
25. Waugh JM, Clagett OT. Resection of the duodenum and head of the pancreas for carcinoma; an analysis of thirty cases. Surgery, 1946, 20:224-232.
26. Menahem B, Guittet L, Mulliri A, et al. Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy:an updated meta-analysis of randomized controlled trials. Ann Surg, 2015, 261(5):882-887.
27. Rault A, SaCunha A, Klopfenstein D, et al. Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for longterm outcomes of pancreatic exocrine function. J Am Coll Surg, 2005, 201(2):239-244.

Previous Article
Application Value of CT in Preoperative Diagnosis of Omental Torsion
Next Article
腹腔镜手术对中低位直肠癌患者免疫功能和切口感染的影响

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A Meta-Analysis of Pancreaticojejunostomy on Postoperative Outcomes Following Pan-creaticoduodenectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content