Postoperative pancreatic fistula after pancreaticogastrostomy versus pancreatojejunostomy after pancreatic resection, a comparative systematic review and meta‐analysis

Abstract

BackgroundIn patients undergoing pancreaticoduodenectomy (PD), there has been some evidence favoring pancreaticogastrostomy (PG) over pancreatojejunostomy (PJ) in the occurrence of postoperative pancreatic fistulas (POPF) and considering PG as a safer anastomotic technique. However, other publications revealed comparable incidences of POPF attributed to both techniques. The current work attempts to reach a more consolidated conclusion about such an issue.MethodsThis is a systematic review and meta‐analysis that analyzed the studies comparing PG and PJ during PD in terms of the rate of POPF occurrence. Studies were obtained by searching the Scopus, PubMed Central, and Cochrane Central Register of Controlled Trials databases.Results35 articles published between 1995 and 2022 presented data from 14,666 patients; 4547 underwent PG and 10,119 underwent PJ. Statistically significant lower rates of POPF (p = 0.044) and clinically relevant CR‐POPF (p = 0.043) were shown in the PG group. The post‐pancreatectomy hemorrhage (PPH) was significantly higher in the PG group, while no significant difference was found between the two groups in the clinically significant PPH. No statistically significant differences were found regarding the amount of intraoperative blood loss, length of hospital stay, DGE, overall morbidity rates, reoperation rates, or mortality rates. The percentage of male sex in the PG group and the percentage of soft pancreas in the PJ group seem to influence the odds ratio of CR‐POPF (p = 0.076 and 0.074, respectively).ConclusionThe present study emphasizes the superiority of PG over PJ regarding CR‐POPF rates. Higher rates of postoperative hemorrhage were associated with PG. Yet, the clinically significant hemorrhage rate was comparable between the two groups.

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreatic head resection: An updated meta‐analysis

“…Moreover, postpancreatectomy hemorrhage (PPH) (p = 0.018) was significantly higher in the PG group, while no significant difference was found between the two groups in the clinically relevant PPH (CR-PPH). 1 No statistically significant differences were found regarding the amount of intraoperative blood loss, length of hospital stay, delayed gastric emptying (DGE), biliary fistula, overall morbidity, reoperation, and mortality rates. 1 However, Salman et al did not include subgroup analysis related to study design (RCT, in particular), although we strongly believe this to be mandatory, when statistically more robust evidence is pursued.…”

“…1 No statistically significant differences were found regarding the amount of intraoperative blood loss, length of hospital stay, delayed gastric emptying (DGE), biliary fistula, overall morbidity, reoperation, and mortality rates. 1 However, Salman et al did not include subgroup analysis related to study design (RCT, in particular), although we strongly believe this to be mandatory, when statistically more robust evidence is pursued. Therefore, starting from the results of the systematic research carried out by Salman et al, 1 our meta-analysis enclosed all outcomes introduced by authors, solely including RCTs.…”

“…Dear Editor, Great interest aroused our reading of Salman et al's "Postoperative pancreatic fistula after pancreaticogastrostomy versus pancreatojejunostomy after pancreatic resection, a comparative systematic review and metaanalysis," recently published by the World Journal of Surgery. 1 Authors performed an updated meta-analysis of comparative studies with the aim of achieving updated and more effective conclusions on this issue. 1 Out of the 35 identified studies, 13 were randomized controlled trials (RCTs) and 21 were no-RCTs, mainly from European countries and including a pooled population of 14,666 patients (4,547 PG vs. 10,119 PJ).…”

“…1 Authors performed an updated meta-analysis of comparative studies with the aim of achieving updated and more effective conclusions on this issue. 1 Out of the 35 identified studies, 13 were randomized controlled trials (RCTs) and 21 were no-RCTs, mainly from European countries and including a pooled population of 14,666 patients (4,547 PG vs. 10,119 PJ). 1 Statistically significant lower rates of postoperative pancreatic fistula (POPF) (p = 0.044) and clinically relevant POPF (CR-POPF) (p = 0.043) were shown in the PG group.…”

“…1 Out of the 35 identified studies, 13 were randomized controlled trials (RCTs) and 21 were no-RCTs, mainly from European countries and including a pooled population of 14,666 patients (4,547 PG vs. 10,119 PJ). 1 Statistically significant lower rates of postoperative pancreatic fistula (POPF) (p = 0.044) and clinically relevant POPF (CR-POPF) (p = 0.043) were shown in the PG group. Moreover, postpancreatectomy hemorrhage (PPH) (p = 0.018) was significantly higher in the PG group, while no significant difference was found between the two groups in the clinically relevant PPH (CR-PPH).…”