Meta-analysis of delayed gastric emptying after pylorus-preserving <i>versus</i> pylorus-resecting pancreatoduodenectomy

Klaiber, Ulla; Probst, Pascal; Strobel, Oliver; Michalski, C. W.; Dörr-Harim, Colette; Diener, Markus K.; Büchler, Markus W.; Hackert, Thilo

doi:10.1002/bjs.10771

Cited by 63 publications

(51 citation statements)

References 36 publications

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“…The German cohort was less likely to develop DGE than the Dutch cohort (10⋅9 versus 18⋅0 per cent). The main reason for DGE is postoperative complications 47,48 . As overall major complication rates were similar between cohorts in the present study and published DGE rates mostly vary between 15 and 40 per cent 49 , reporting or classification bias seems the most likely explanation for the difference in DGE rates.…”

Section: Discussionmentioning

confidence: 99%

Variation in pancreatoduodenectomy as delivered in two national audits

Mackay

Wellner

Rijssen

et al. 2019

British Journal of Surgery

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Background: Nationwide audits facilitate quality and outcome assessment of pancreatoduodenectomy. Differences may exist between countries but studies comparing nationwide outcomes of pancreatoduodenectomy based on audits are lacking. This study aimed to compare the German and Dutch audits for external data validation.Methods: Anonymized data from patients undergoing pancreatoduodenectomy between 2014 and 2016 were extracted from the German Society for General and Visceral Surgery StuDoQ|Pancreas and Dutch Pancreatic Cancer Audit, and compared using descriptive statistics. Univariable and multivariable risk analyses were undertaken.Results: Overall, 4495 patients were included, 2489 in Germany and 2006 in the Netherlands. Adenocarcinoma was a more frequent indication for pancreatoduodenectomy in the Netherlands. German patients had worse ASA fitness grades, but Dutch patients had more pulmonary co-morbidity. Dutch patients underwent more minimally invasive surgery and venous resections, but fewer multivisceral resections. No difference was found in rates of grade B/C postoperative pancreatic fistula, grade C postpancreatectomy haemorrhage and in-hospital mortality. There was more centralization in the Netherlands (1⋅3 versus 13⋅3 per cent of pancreatoduodenectomies in very low-volume centres; P < 0⋅001). In multivariable analysis, both hospital stay (difference 2⋅49 (95 per cent c.i. 1⋅18 to 3⋅80) days) and risk of reoperation (odds ratio (OR) 1⋅55, 95 per cent c.i. 1⋅22 to 1⋅97) were higher in the German audit, whereas risk of postoperative pneumonia (OR 0⋅57, 0⋅37 to 0⋅88) and readmission (OR 0⋅38, 0⋅30 to 0⋅49) were lower. Several baseline and surgical characteristics, including hospital volume, but not country, predicted mortality.Conclusion: This comparison of the German and Dutch audits showed variation in case mix, surgical technique and centralization for pancreatoduodenectomy, but no difference in mortality and pancreasspecific complications.

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Section: Discussionmentioning

confidence: 99%

Variation in pancreatoduodenectomy as delivered in two national audits

Mackay

Wellner

Rijssen

et al. 2019

British Journal of Surgery

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“…A recent randomized controlled trial [35] comparing PD with pylorus-resecting or pyloruspreserving did not showed significant difference in DGE rate. Finally, a recent metaanalysis [36] showed superiority for pylorus-resecting pancreaticoduodenectomy regarding DGE when all studies are included.…”

Section: Discussionmentioning

confidence: 99%

Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?

Gaignard

Bergeat

Courtin-Tanguy

et al. 2018

Langenbecks Arch Surg

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“…This currently largest RCT was designed and planned with the attempt to overcome the limitations of previous trials with non-blinded trial designs and missing adherence to consensus definitions for outcome parameters. We currently performed a systematic review and meta-analysis to give an update of critically appraised and quantitative data on the effectiveness and safety of pylorus-preserving compared to pylorus-resecting PD (58). Table 2 summarizes the available randomized trials.…”

Section: Resection Of the Pylorus Does Not Reduce Dgementioning

confidence: 99%

“…Table 2 summarizes the available randomized trials. Meta-analysis of the three existing RCTs showed no significant statistical difference between the two procedures for DGE and other relevant outcome parameters including postoperative pancreatic fistula, postpancreatectomy hemorrhage, intra-abdominal fluid collection/abscess, bile leakage, wound infection, pulmonary complications, mortality, reoperations, perioperative blood loss, duration of operation, and length of hospital stay (58). To account for differences in reconstruction techniques, sensitivity analyses were performed.…”

Section: Resection Of the Pylorus Does Not Reduce Dgementioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons.After its oncological adequacy was questioned initially, pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that pylorus resection does not reduce DGE compared to the pyloruspreserving operation. Non-superiority of pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without pylorus preservation and derives recommendations for daily practice.

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Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy

Abstract: Pylorus-resecting pancreatoduodenectomy is not superior to pylorus-preserving pancreatoduodenectomy for reducing DGE or other relevant complications.

Cited by 63 publications

References 36 publications

Variation in pancreatoduodenectomy as delivered in two national audits

Variation in pancreatoduodenectomy as delivered in two national audits

Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?

Pylorus preservation pancreatectomy or not

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