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

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.