European Journal of Surgical Oncology
Volume 34, Issue 11 , Pages 1237-1245 , November 2008

A comparison of pancreaticoduodenectomy with pylorus preserving pancreaticoduodenectomy: A meta-analysis of 2822 patients

  • N. Iqbal

      Affiliations

    • Barts and The London HPB Centre, The Royal London Hospital, London, UK
    • ,
  • R.E. Lovegrove

      Affiliations

    • Imperial College London, Department of Biosurgery and Surgical Technology, St Mary's Hospital, London, UK
    • ,
  • H.S. Tilney

      Affiliations

    • Imperial College London, Department of Biosurgery and Surgical Technology, St Mary's Hospital, London, UK
    • ,
  • A.T. Abraham

      Affiliations

    • Barts and The London HPB Centre, The Royal London Hospital, London, UK
    • ,
  • S. Bhattacharya

      Affiliations

    • Barts and The London HPB Centre, The Royal London Hospital, London, UK
    • ,
  • P.P. Tekkis

      Affiliations

    • Imperial College London, Department of Biosurgery and Surgical Technology, St Mary's Hospital, London, UK
    • ,
  • H.M. Kocher

      Affiliations

    • Barts and The London HPB Centre, The Royal London Hospital, London, UK
    • Corresponding Author InformationCorresponding author. Barts and The London HPB Centre, The Royal London Hospital, Whitechapel, London E1 1BB, UK. Tel.: +44 20 7014 0416; fax: +44 20 7014 0400.

,Accepted 17 December 2007.

References 

  1. O'Sullivan A, Kocher HM. Pancreatic cancer. BMJ Clin Evid. 2007;11:409–436
  2. Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350(12):1200–1210
  3. Kausch W. Das Carcinom der Papilla duodeni und seine radikale Entfernung. Beitr Klin Chir. 1912;78:439–486
  4. Whipple A, Parson W, Mullins C. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102:763–779
  5. Trede M, Carter DC. Surgery of the pancreas. Edinburgh: Churchill Livingstone; 1993;
  6. Watson K. Carcinoma of ampulla of Vater. Successful radical resection. Br J Surg. 1944;31:368–373
  7. Braasch JW, Deziel DJ, Rossi RL, Watkins E, Winter PF. Pyloric and gastric preserving pancreatic resection. Experience with 87 patients. Ann Surg. 1986;204(4):411–418
  8. Traverso LW, Longmire WP. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978;146(6):959–962
  9. Braasch JW, Rossi RL. Pyloric preservation with the Whipple procedure. Surg Clin N Am. 1985;65(2):263–271
  10. Lin PW, Shan YS, Lin YJ, Hung CJ. Pancreaticoduodenectomy for pancreatic head cancer: PPPD versus Whipple procedure. Hepatogastroenterology. 2005;52(65):1601–1604
  11. Seiler CA, Wagner M, Bachmann T, et al. Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg. 2005;92(5):547–556
  12. Tran KT, Smeenk HG, van Eijck CH, et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg. 2004;240(5):738–745
  13. Kozuschek W, Reith HB, Waleczek H, Haarmann W, Edelmann M, Sonntag D. A comparison of long term results of the standard Whipple procedure and the pylorus preserving pancreatoduodenectomy. J Am Coll Surg. 1994;178(5):443–453
  14. Belli L, Riolo F, Romani F, Baticci F, Rossetti O, Puttini M. Pylorus preserving pancreatoduodenectomy versus Whipple procedure for adenocarcinoma of the head of the pancreas. HPB Surg. 1989;1(3):195–200
  15. Haarmann W, Busing M, Reith HB, Wysocki P, Kozuschek W. The oncological approach to pylorus preserving pancreatoduodenectomy (PPPD) in pancreas malignancies. Wiad Lek. 1997;50(Suppl 1 Pt 2):140–144
  16. Mosca F, Giulianotti PC, Balestracci T, et al. Long-term survival in pancreatic cancer: pylorus-preserving versus Whipple pancreatoduodenectomy. Surgery. 1997;122(3):553–566
  17. Takao S, Aikou T, Shinchi H, et al. Comparison of relapse and long-term survival between pylorus-preserving and Whipple pancreaticoduodenectomy in periampullary cancer. Am J Surg. 1998;176(5):467–470
  18. Roder JD, Stein HJ, Huttl W, Siewert JR. Pylorus-preserving versus standard pancreatico-duodenectomy: an analysis of 110 pancreatic and periampullary carcinomas. Br J Surg. 1992;79(2):152–155
  19. Clarke M, Horton R. Bringing it all together: Lancet-Cochrane collaborate on systematic reviews. Lancet. 2001;357(9270):1728
  20. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–2012
  21. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–634
  22. Haldane JB. The estimation and significance of the logarithm of a ratio of frequencies. Ann Hum Genet. 1956;20(4):309–311
  23. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719–748
  24. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–188
  25. Sterne JA, Davey Smith G. Sifting the evidence-what's wrong with significance tests?. BMJ. 2001;322(7280):226–231
  26. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med. 1998;17(24):2815–2834
  27. Athanasiou T, Al-Ruzzeh S, Kumar P, et al. Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg. 2004;77(2):745–753
  28. Egger M, Smith GD. Misleading meta-analysis. BMJ. 1995;311(7007):753–754
  29. Di Carlo V, Zerbi A, Balzano G, Corso V. Pylorus-preserving pancreaticoduodenectomy versus conventional Whipple operation. World J Surg. 1999;23(9):920–925
  30. Grace PA, Pitt HA, Longmire WP. Pancreatoduodenectomy with pylorus preservation for adenocarcinoma of the head of the pancreas. Br J Surg. 1986;73(8):647–650
  31. Horstmann O, Markus PM, Ghadimi MB, Becker H. Pylorus preservation has no impact on delayed gastric emptying after pancreatic head resection. Pancreas. 2004;28(1):69–74
  32. Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL. Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg. 2000;231(3):293–300
  33. Klinkenbijl JH, van der Schelling GP, Hop WC, van Pel R, Bruining HA, Jeekel J. The advantages of pylorus-preserving pancreatoduodenectomy in malignant disease of the pancreas and periampullary region. Ann Surg. 1992;216(2):142–145
  34. Lin PW, Lin YJ. Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy. Br J Surg. 1999;86(5):603–607
  35. Makhija R, Tsai P, Kingsnorth A. Pylorus-preserving pancreatoduodenectomy with Billroth I type reconstruction: a viable option for pancreatic head resection. J Hepatobiliary Pancreat Surg. 2002;9(5):614–619
  36. McAfee MK, van Heerden JA, Adson MA. Is proximal pancreatoduodenectomy with pyloric preservation superior to total pancreatectomy?. Surgery. 1989;105(3):347–351
  37. Morel P, Mathey P, Corboud H, Huber O, Egeli RA, Rohner A. Pylorus-preserving duodenopancreatectomy: long-term complications and comparison with the Whipple procedure. World J Surg. 1990;14(5):642–646
  38. Ogata Y, Hishinuma S. The impact of pylorus-preserving pancreatoduodenectomy on surgical treatment for cancer of the pancreatic head. J Hepatobiliary Pancreat Surg. 2002;9(2):223–232
  39. Ohtsuka T, Yamaguchi K, Ohuchida J, et al. Comparison of quality of life after pylorus-preserving pancreatoduodenectomy and Whipple resection. Hepatogastroenterology. 2003;50(51):846–850
  40. Patel AG, Toyama MT, Kusske AM, Alexander P, Ashley SW, Reber HA. Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better?. Arch Surg. 1995;130(8):838–842
  41. Sadowski C, Uhl W, Baer HU, Reber P, Seiler CA, Buchler MW. Delayed gastric emptying after classic and pylorus-preserving Whipple procedure. A prospective study. Dig Surg. 1997;14:159–164
  42. Seiler CA, Wagner M, Sadowski C, Kulli C, Buchler MW. Randomized prospective trial of pylorus-preserving vs. Classic duodenopancreatectomy (Whipple procedure): initial clinical results. J Gastrointest Surg. 2000;4(5):443–452
  43. Seiler CA, Wagner M, Schaller B, Sadowski C, Kulli C, Buchler MW. [Pylorus preserving or classical Whipple operation in tumors. Initial clinical results of a prospective randomized study]. Swiss Surg. 2000;6(5):275–282
  44. Takada T, Yasuda H, Amano H, Yoshida M, Ando H. Results of a pylorus-preserving pancreatoduodenectomy for pancreatic cancer: a comparison with results of the Whipple procedure. Hepatogastroenterology. 1997;44(18):1536–1540
  45. Takada T, Yasuda H, Shikata J, Watanabe S, Shiratori K, Takeuchi T. Postprandial plasma gastrin and secretin concentrations after a pancreatoduodenectomy. A comparison between a pylorus-preserving pancreatoduodenectomy and the Whipple procedure. Ann Surg. 1989;210(1):47–51
  46. Thor PJ, Matyja A, Popiela T, Szybinski Z, Huszno B, Sobocki J. Early effects of standard and pylorus-preserving pancreatectomy on myoelectric activity and gastric emptying. Hepatogastroenterology. 1999;46(27):1963–1967
  47. Tsao JI, Rossi RL, Lowell JA. Pylorus-preserving pancreatoduodenectomy. Is it an adequate cancer operation. Arch Surg. 1994;129(4):405–412
  48. van Berge Henegouwen MI, Moojen TM, van Gulik TM, Rauws EA, Obertop H, Gouma DJ. Postoperative weight gain after standard Whipple's procedure versus pylorus-preserving pancreatoduodenectomy: the influence of tumour status. Br J Surg. 1998;85(7):922–926
  49. van Berge Henegouwen MI, van Gulik TM, DeWit LT, et al. Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg. 1997;185(4):373–379
  50. Wang TY, Shyr YM, Su CH, Wu CW, Lui WY. Comparison of pylorus-preserving and classic pancreaticoduodenectomy. Zhonghua Yi Xue Za Zhi (Taipei). 1999;62(3):152–158
  51. Watanapa P, Williamson RC. Resection of the pancreatic head with or without gastrectomy. World J Surg. 1995;19(3):403–409
  52. Wenger FA, Jacobi CA, Haubold K, Zieren HU, Muller JM. [Gastrointestinal quality of life after duodenopancreatectomy in pancreatic carcinoma. Preliminary results of a prospective randomized study: pancreatoduodenectomy or pylorus-preserving pancreatoduodenectomy]. Chirurg. 1999;70(12):1454–1459
  53. Williamson RC, Bliouras N, Cooper MJ, Davies ER. Gastric emptying and enterogastric reflux after conservative and conventional pancreatoduodenectomy. Surgery. 1993;114(1):82–86
  54. Yamaguchi K, Kishinaka M, Nagai E, et al. Pancreatoduodenectomy for pancreatic head carcinoma with or without pylorus preservation. Hepatogastroenterology. 2001;48(41):1479–1485
  55. Yamaguchi K, Yokohata K, Nakano K, et al. Which is a less invasive pancreatic head resection: PD, PPPD, or DPPHR?. Dig Dis Sci. 2001;46(2):282–288
  56. Zerbi A, Balzano G, Patuzzo R, Calori G, Braga M, Di Carlo V. Comparison between pylorus-preserving and Whipple pancreatoduodenectomy. Br J Surg. 1995;82(7):975–979
  57. Mosca F, Giulianotti PC, Balestracci T, et al. [Preservation of the pylorus in duodenocephalopancreatectomy in pancreatic and periampullary carcinoma]. Chir Ital. 1994;46(2):59–67
  58. Kovacs I, Toth P, Arkosy J, Hamori J, Sapy P. Surgical treatment of pancreatic head and periampullary tumours. Acta Chir Hung. 1997;36(1–4):172–173
  59. Takahashi S, Aiura K, Saitoh J, Hayatsu S, Kitajima M, Ogata Y. Treatment strategy for pancreatic head cancer: Pylorus-Preserving Pancreaticoduodenectomy, Intraoperative Radiotherapy and Portal Catheterization. Digestion. 1999;60(Suppl 1):130–134
  60. Paquet KJ. Vergleich der partiellen Duodenopankreatektomi (Whipple-Operation) mit der pyloruserhaltenden Zephaloduodenopankreatektomie-eine prospektiv kontrollierte, randomisierte Langzeitstudie. Chir Gastroenterol. 1998;14:54–58
  61. Schoenberg MH, Gansauge F, Kunz R. Die Wertigkeit der pyloruserhaltenden partiellen Duodenopankreatektomie beim duktalen Pankreascarcinom. Chirurg. 1997;68(12):1262–1267
  62. Heise JW, Becker H, Borchard F, Roher HD. Zum Radikalitatsrisiko der pyloruserhaltenden Duodenopamkreatektomie beim duktalen Carcinom. Chirurg. 1994;65:780–784
  63. Hocking MP, Harrison WD, Sninsky CA. Gastric dysrhythmias following pylorus-preserving pancreaticoduodenectomy. Possible mechanism for early delayed gastric emptying. Dig Dis Sci. 1990;35(10):1226–1230
  64. Tanaka M, Sarr MG. Total duodenectomy: feect on canine gastrointestinal motility. J Surg Res. 1987;42(5):483–493
  65. Tanaka M, Sarr MG. Role of the duodenum in the control of canine gastrointestinal motility. Gastroenterology. 1988;94(3):622–629
  66. Fraser R, Fone D, Horowitz M, Dent J. Cholecystokinin octapeptide stimulates phasic and tonic pyloric motility in healthy humans. Gut. 1993;34(1):33–37
  67. Yeo CJ, Barry MK, Sauter PK, et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg. 1993;218(3):229–237discussion 237–228
  68. Bar-Natan M, Larson GM, Stephens G, Massey T. Delayed gastric emptying after gastric surgery. Am J Surg. 1996;172(1):24–28
  69. Garcea G, Dennison AR, Ong SL, et al. Tumour characteristics predictive of survival following resection for ductal adenocarcinoma of the head of pancreas. Eur J Surg Oncol. 2007;33(7):892–897
  70. Kleeff J, Michalski CW, Friess H, Buchler MW. Surgical treatment of pancreatic cancer: the role of adjuvant and multimodal therapies. Eur J Surg Oncol. 2007;33(7):817–823

☆ This work was presented in the Poster Presentation session at 7th World Congress of International Hepato-Pancreato-Biliary Association on 5 September 2006 in Edinburgh, Scotland and abstracted as HPB 2006;8(Suppl 2):224.

PII: S0748-7983(07)00667-1

doi: 10.1016/j.ejso.2007.12.004

European Journal of Surgical Oncology
Volume 34, Issue 11 , Pages 1237-1245 , November 2008

Article Tools

* Image Usage & Resolution