The pylorus: take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer.

TY - JOUR

T1 - The pylorus: take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer.

AU - Karanicolas, Paul J

AU - Davies, Edward

AU - Kunz, Regina

AU - Briel, Matthias

AU - Koka, H Pavan

AU - Payne, Darrin M

AU - Smith, Shona E

AU - Hsu, Hui-Ping

AU - Lin, Pin-Wen

AU - Blöchle, Christian

AU - Paquet, Karl-Joseph

AU - Guyatt, Gordon H

PY - 2007

Y1 - 2007

N2 - BACKGROUND: Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer. METHODS: We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. RESULTS: Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P <.001, 95% confidence interval [95% CI], 53-92), with 284 mL less blood loss (P <.001, 95% CI, 176-391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25-1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. CONCLUSIONS: Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.

AB - BACKGROUND: Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer. METHODS: We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. RESULTS: Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P <.001, 95% confidence interval [95% CI], 53-92), with 284 mL less blood loss (P <.001, 95% CI, 176-391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25-1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. CONCLUSIONS: Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.

M3 - SCORING: Zeitschriftenaufsatz

VL - 14

SP - 1825

EP - 1834

JO - ANN SURG ONCOL

JF - ANN SURG ONCOL

SN - 1068-9265

IS - 6

M1 - 6

ER -