Abstract
Background
The gold-standard for surgical excision of peri-ampullary tumours has not been established
despite numerous studies, due to conflicting outcomes.
Aim
To consolidate the published evidence and compare outcomes between pancreaticoduodenectomy
(PD) and pylorus preserving pancreaticoduodenectomy (PPPD) across all published comparative
studies.
Methods
Using meta-analytical techniques the study compared: operative details, post-operative
adverse events and survival following PD and PPPD. Comparative studies published between
1986 and 2005 of PD versus PPPD were included. A random effect model was employed,
with significance reported at the 5% level.
Results
32 studies comprising 2822 patients (1335 PD and 1487 PPPD), including 5 randomized
controlled trials with 421 patients (215 PD and 206 PPPD) were included. Patients
undergoing PPPD were found to have smaller tumours (weighted mean difference (WMD)
−0.54 cm, p = 0.030), although no significant difference in the number of patients with stage III
or IV disease existed between the groups (odds ratio, OR 1.55, p = 0.320). Decreased operating times (WMD −41.3 min, p = 0.010) and fewer blood transfusions (WMD −0.9 units, p < 0.001) were observed in the PPPD group. There was no difference in post-operative
complications, including pancreatic and biliary leaks or fistulae, between the two
groups. It was suggested that peri-operative mortality was decreased in the PPPD group
(OR 1.7, p = 0.040), and overall survival was better (hazard ratio (HR) 0.66, p = 0.02), although this did not remain significant on subgroup analysis.
Conclusions
Both PD and PPPD had similar peri-operative adverse events, however, in overall analysis
PPPD has lower mortality and improved long-term patient survival, although this was
not reflected in the sub-group analysis.
Keywords
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Article info
Publication history
Accepted:
December 17,
2007
Footnotes
☆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.
Identification
Copyright
© 2007 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
