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Meta-Analysis
. 2016 Feb 16;2(2):CD006053.
doi: 10.1002/14651858.CD006053.pub6.

Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma

Felix J Hüttner  1 , Christina Fitzmaurice, Guido Schwarzer, Christoph M Seiler, Gerd Antes, Markus W Büchler, Markus K Diener
Affiliations
Meta-Analysis

Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma

Felix J Hüttner et al. Cochrane Database Syst Rev. .

Abstract

Background: Pancreatic cancer is the fourth-leading cause of cancer death for both, men and women. The standard treatment for resectable tumours consists of a classic Whipple (CW) operation or a pylorus-preserving pancreaticoduodenectomy (PPW). It is unclear which of these procedures is more favourable in terms of survival, postoperative mortality, complications, and quality of life.

Objectives: The objective of this systematic review was to compare the effectiveness of CW and PPW techniques for surgical treatment of cancer of the pancreatic head and the periampullary region.

Search methods: We conducted searches on 28 March 2006, 11 January 2011, 9 January 2014, and 18 August 2015 to identify all randomised controlled trials (RCTs), while applying no language restrictions. We searched the following electronic databases on 18 August 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) from the Cochrane Library (2015, Issue 8); MEDLINE (1946 to August 2015); and EMBASE (1980 to August 2015). We also searched abstracts from Digestive Disease Week and United European Gastroenterology Week (1995 to 2010); we did not update this part of the search for the 2014 and 2015 updates because the prior searches did not contribute any additional information. We identified two additional trials through the updated search in 2015.

Selection criteria: RCTs comparing CW versus PPW including participants with periampullary or pancreatic carcinoma.

Data collection and analysis: Two review authors independently extracted data from the included trials. We used a random-effects model for pooling data. We compared binary outcomes using odds ratios (ORs), pooled continuous outcomes using mean differences (MDs), and used hazard ratios (HRs) for meta-analysis of survival. Two review authors independently evaluated the methodological quality and risk of bias of included trials according to the standards of The Cochrane Collaboration.

Main results: We included eight RCTs with a total of 512 participants. Our critical appraisal revealed vast heterogeneity with respect to methodological quality and outcome parameters. Postoperative mortality (OR 0.64, 95% confidence interval (CI) 0.26 to 1.54; P = 0.32), overall survival (HR 0.84, 95% CI 0.61 to 1.16; P = 0.29), and morbidity showed no significant differences, except of delayed gastric emptying, which significantly favoured CW (OR 3.03, 95% CI 1.05 to 8.70; P = 0.04). Furthermore, we noted that operating time (MD -45.22 minutes, 95% CI -74.67 to -15.78; P = 0.003), intraoperative blood loss (MD -0.32 L, 95% CI -0.62 to -0.03; P = 0.03), and red blood cell transfusion (MD -0.47 units, 95% CI -0.86 to -0.07; P = 0.02) were significantly reduced in the PPW group. All significant results were associated with low-quality evidence based on GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria.

Authors' conclusions: Current evidence suggests no relevant differences in mortality, morbidity, and survival between the two operations. However, some perioperative outcome measures significantly favour the PPW procedure. Given obvious clinical and methodological heterogeneity, future high-quality RCTs of complex surgical interventions based on well-defined outcome parameters are required.

PubMed Disclaimer

Conflict of interest statement

MKD: none known.

CF: holds a T32 NIH training grant (United States of America).

GS: none known.

CMS: none known.

FJH: none known.

GA: none known.

MWB: none known.

Figures

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1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Study flow diagram.
4
4
Funnel plot of comparison: 1 Survival, outcome: 1.1 Overall.
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5
Funnel plot of comparison: 2 Postoperative mortality, outcome: 2.1 Postoperative mortality.
6
6
Funnel plot of comparison: 3 Pancreatic fistula, outcome: 3.1 Pancreatic fistula.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bloechle 1999 {published data only}
    1. Bloechle C, Broering DC, Latuske C. Prospective randomized study to evaluate quality of life after partial pancreatoduodenectomy according to Whipple versus pylorus preserving pancreatoduodenectomy according to Longmire‐Traverso for periampullary carcinoma. Deutsche Gesellschaft für Chirurgie 1999;Supplement 1, Forumband:661‐4.
Lin 1999 {published data only}
    1. Lin PW, Lin YJ. Prospective randomized comparison between pylorus‐preserving and standard pancreaticoduodenectomy. British Journal of Surgery 1999;86(5):603‐7. - PubMed
    1. Lin PW, Shan YS, Lin YJ, Hung CJ. Pancreaticoduodenectomy for pancreatic head cancer: PPPD versus Whipple procedure. Hepatogastroenterology 2005;52(65):1601‐4. - PubMed
Paquet 1998 {published data only}
    1. Paquet K‐J. Comparison of Whipple's pancreaticoduodenectomy with the pylorus‐preserving pancreaticoduodenectomy ‐ a prospectively controlled, randomized long‐term trial [Vergleich der partiellen Duodenopankreatektomie (Whipple‐Operation) mit der pyloruserhaltenden Zephaloduodenopankreatektomie ‐ eine prospektive kontrollierte, randomisierte Langzeitstudie]. Chirurgische Gastroenterologie 1998;14:54‐8.
Seiler 2005 {published data only}
    1. Seiler CA, Wagner M, Bachmann T, Redaelli CA, Schmied B, Uhl W, et al. Randomized clinical trial of pylorus‐preserving duodenopancreatectomy versus classical Whipple resection ‐ long term results. British Journal of Surgery 2005;92(5):547‐56. - PubMed
Srinarmwong 2008 {published data only}
    1. Srinarmwong C, Luechakiettisak P, Prasitvilai W. Standard Whipple's operation versus pylorus preserving pancreaticoduodenectomy: a randomized controlled trial study. Journal of the Medical Association of Thailand 2008;91(5):693‐8. - PubMed
Taher 2015 {published data only}
    1. Taher MA, Khan ZR, Chowdhury MM, Nur‐E‐Elahi M, Chowdhury AK, Faruque MS, et al. Pylorus preserving pancreaticoduodenectomy vs. standard Whipple's procedure in case of carcinoma head of the pancreas and periampullary carcinoma. Mymensingh Medical Journal 2015;24(2):319‐25. - PubMed
Tran 2004 {published data only}
    1. Tran KT, Smeenk HG, Eijck CH, Kazemier G, Hop WC, Greve JW, et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Annals of Surgery 2004;240(5):738‐45. - PMC - PubMed
Wenger 1999 {published data only}
    1. 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;70:1454‐9. - PubMed

References to studies excluded from this review

Bakkevold 1993 {published data only}
    1. Bakkevold KE, Kambestad B. Morbidity and mortality after radical and palliative pancreatic cancer surgery. Risk factors influencing the short‐term results. Annals of Surgery 1993;217(4):356‐68. - PMC - PubMed
Bassi 1994 {published data only}
    1. Bassi C, Falconi M, Lobardi D, Briani G, Vesentini S, Camboni MG, et al. Prophylaxis of complications after pancreatic surgery: results of a multicenter trial in Italy. Italian Study Group. Digestion 1994;55(Suppl 1):41‐7. - PubMed
Bell 2005 {published data only}
    1. Bell RH Jr. Pancreaticoduodenectomy with or without pylorus preservation have similar outcomes. Cancer Treatment Reviews 2005;31(4):328‐31. - PubMed
Brennan 1994 {published data only}
    1. Brennan MF, Pisters PW, Posner M, Quesada O, Shike M. A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy. Annals of Surgery 1994;220(4):436‐41; discussion 441‐4. - PMC - PubMed
Buchler 1993 {published data only}
    1. Buchler M, Friess H. Prevention of postoperative complications following pancreatic surgery. Digestion 1993;54(Suppl 1):41‐6. - PubMed
Chou 1996 {published data only}
    1. Chou FF, Sheen‐Chen SM, Chen YS, Chen MC, Chen CL. Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. European Journal of Surgery 1996;162(6):477‐81. - PubMed
Farnell 2005 {published data only}
    1. Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 2005;138(4):618‐28; discussion 628‐30. - PubMed
Friess 1996 {published data only}
    1. Friess H, Berberat P, Schilling M, Kunz J, Korc M, Buchler MW. Pancreatic cancer: the potential clinical relevance of alterations in growth factors and their receptors. Journal of Molecular Medicine 1996;74(1):35‐42. - PubMed
Johnstone 1993 {published data only}
    1. Johnstone PA, Sindelar WF. Lymph node involvement and pancreatic resection: correlation with prognosis and local disease control in a clinical trial. Pancreas 1993;8(5):535‐9. - PubMed
Nguyen 2003 {published data only}
    1. Nguyen TC, Sohn TA, Cameron JL, Lillemoe KD, Campbell KA, Coleman J, et al. Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. Journal of Gastrointestinal Surgery 2003;7(1):1‐9; discussion 9‐11. - PubMed
Pedrazzoli 1998 {published data only}
    1. Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Annals of Surgery 1998;228(4):508‐17. - PMC - PubMed
Seiler 2000 {published data only}
    1. Seiler CA, Wagner M, Sadowski C, Kulli C, Buchler MW. Randomized prospective trial of pylorus‐preserving vs. classic duodenopancreatectomy (Whipple procedure): initial clinical results. Journal of Gastrointestinal Surgery 2000;4(5):443‐52. [PUBMED: 11077317] - PubMed
Shan 2003 {published data only}
    1. Shan YS, Sy ED, Lin PW. Role of somatostatin in the prevention of pancreatic stump‐related morbidity following elective pancreaticoduodenectomy in high‐risk patients and elimination of surgeon‐related factors: prospective, randomized, controlled trial. World Journal of Surgery 2003;27(6):709‐14. - PubMed
van Berge Henegouwen {published data only}
    1. Berge Henegouwen MI, Moojen TM, 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. British Journal of Surgery 1998;85(7):922‐6. - PubMed
Wagner 2004 {published data only}
    1. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. British Journal of Surgery 2004;91(5):586‐94. - PubMed
Yeo 1999 {published data only}
    1. Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short‐term outcome. Annals of Surgery 1999;229(5):613‐22; discussion 622‐4. - PMC - PubMed

Additional references

Bassi 2001
    1. Bassi C, Falconi M, Salvia R, Mascetta G, Molinari E, Pederzoli P. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Digestive Surgery 2001;18(6):453‐7. - PubMed
Bassi 2005a
    1. Bassi C, Stocken DD, Olah A, Friess H, Buckels J, Hickey H, et al. Influence of surgical resection and post‐operative complications on survival following adjuvant treatment for pancreatic cancer in the ESPAC‐1 randomized controlled trial. Digestive Surgery 2005;22(5):353‐63. - PubMed
Bassi 2005b
    1. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138(1):8‐13. - PubMed
Buchler 2003
    1. Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z'graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Archives of Surgery 2003;138(12):1310‐4. - PubMed
Butturini 2006
    1. Butturini G, Marcucci S, Molinari E, Mascetta G, Landoni L, Crippa S, et al. Complications after pancreaticoduodenectomy: the problem of current definitions. Journal of Hepato‐Biliary‐Pancreatic Surgery 2006;13(3):207‐11. - PubMed
Cameron 2015
    1. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. Journal of the American College of Surgeons 2015;220(4):530‐6. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7(3):177‐88. - PubMed
Downs 1998
    1. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non‐randomised studies of health care interventions. Journal of Epidemiology & Community Health 1998;52(6):377‐84. - PMC - PubMed
Egger 1997a
    1. Egger M, Davey SG, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629–34. - PMC - PubMed
Egger 1997b
    1. Egger M, Smith GD. Meta‐analysis. Potentials and promise. BMJ 1997;315(7119):1371‐4. - PMC - PubMed
Fitzsimmons 1998
    1. Fitzsimmons D, Johnson CD. Quality of life after treatment of pancreatic cancer. Langenbecks Archives of Surgery 1998;383(2):145‐51. - PubMed
Gouma 1999
    1. Gouma DJ, Nieveen van Dijkum EJ, Geenen RC, Gulik TM, Obertop H. Are there indications for palliative resection in pancreatic cancer?. World Journal of Surgery 1999;23(9):954‐9. - PubMed
Gouma 2000
    1. Gouma DJ, Geenen RC, Gulik TM, Haan RJ, Wit LT, Busch OR, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Annals of Surgery 2000;232(6):786‐95. - PMC - PubMed
GRADE 2008 [Computer program]
    1. Brozek J, Oxman A, Schünemann H. GRADEpro. Version 3.2 for Windows. GRADE Working Group, 2008.
Hackert 2013
    1. Hackert T, Bruckner T, Dörr‐Harim C, Diener MK, Knebel P, Hartwig W, et al. Pylorus resection or pylorus preservation in partial pancreatico‐duodenectomy (PROPP study): study protocol for a randomized controlled trial. Trials 2013;14:44. [DOI: 10.1186/1745-6215-14-44] - DOI - PMC - PubMed
Higgins 2005
    1. Appendix 5b. Highly sensitive search strategies for identifying reports of randomized controlled trials in MEDLINE. In: Higgins JPT, Green S, editors. Cochrane Handbook of Systematic Reviews of Interventions 4.2.5. The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley and Sons, Ltd.
Higgins 2011
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. [DOI: 10.1136/bmj.d5928] - DOI - PMC - PubMed
Hozo 2005
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology 2005;5:13. - PMC - PubMed
Iqbal 2008
    1. Iqbal N, Lovegrove RE, Tilney HS, Abraham AT, Bhattacharya S, Tekkis PP, et al. A comparison of pancreaticoduodenectomy with pylorus preserving pancreaticoduodenectomy: a meta‐analysis of 2822 patients. European Journal of Surgical Oncology 2008;34(11):1237‐45. - PubMed
Karanicolas 2007
    1. Karanicolas PJ, Davies E, Kunz R, Briel M, Koka HP, Payne DM. The pylorus: take it or leave it? Systematic review and meta‐analysis of pylorus‐preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer. Annals of Surgical Oncology 2007;14(6):1825‐34. - PubMed
Kausch 1912
    1. Kausch W. Carcinoma of the duodenal papilla and its radical excision [Das Carcinom der Papilla duodeni und seine radikale Entfernung]. Beitrage zur Klinischen Chirurgie 1912;78:439‐86.
Kawai 2011
    1. Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, et al. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus‐resecting versus pylorus‐preserving pancreatoduodenectomy. Annals of Surgery 2011;253(3):495‐501. - PubMed
Kohler 2015
    1. Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, et al. Annual report to the nation on the status of cancer, 1975‐2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. Journal of the National Cancer Institute 2015;107(6):djv048. [DOI: 10.1093/jnci/djv048] - DOI - PMC - PubMed
Koslowsky 2001
    1. Koslowsky TC, Wilke J, Voiss W, Michaelis S, Balta D, Siedek M. Surgical palliation of pancreatic carcinoma. Results of a 7 year period. Chirurg 2001;72(6):704‐9. - PubMed
Kunz 1998
    1. Kunz R, Oxman AD. The unpredictability paradox: review of empirical comparisons of randomised and non‐randomised clinical trials. BMJ 1998;317:1185‐90. - PMC - PubMed
Lillemoe 1996
    1. Lillemoe KD, Cameron JL, Yeo CJ, Sohn TA, Nakeeb A, Sauter PK, et al. Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer?. Annals of Surgery 1996;223(6):718‐25. - PMC - PubMed
Lillemoe 2000
    1. Lillemoe KD, Yeo CJ, Cameron JL. Pancreatic cancer: state‐of‐the‐art care. CA: A Cancer Journal for Clinicians 2000;50(4):241‐68. - PubMed
Moher 1998
    1. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta‐analyses?. The Lancet 1998;352(9128):609‐13. - PubMed
Mosca 1997
    1. Mosca F, Giulianotti PC, Balestracci T, Candio G, Pietrabissa A, Sbrana F, et al. Long‐term survival in pancreatic cancer: pylorus‐preserving versus Whipple pancreatoduodenectomy. Surgery 1997;122(3):553‐66. - PubMed
Mulrow 1994
    1. Mulrow CD. Rationale for systematic reviews. BMJ 1994;309(6954):597‐9. - PMC - PubMed
Neoptolemos 2001
    1. Neoptolemos JP, Stocken DD, Dunn JA, Almond J, Beger HG, Pederzoli P, et al. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC‐1 randomized controlled trial. Annals of Surgery 2001;234(6):758‐68. - PMC - PubMed
Oettle 2013
    1. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long‐term outcomes among patients with resected pancreatic cancer: the CONKO‐001 randomized trial. JAMA 2013;310(14):1473‐81. - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta‐analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815‐34. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Richter 2003
    1. Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M. Long‐term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25‐year experience. World Journal of Surgery 2003;27(3):324‐9. - PubMed
Roder 1992
    1. Roder JD, Stein HJ, Huttl W, Siewert JR. Pylorus‐preserving versus standard pancreatico‐duodenectomy: an analysis of 110 pancreatic and periampullary carcinomas. British Journal of Surgery 1992;79(2):152‐5. - PubMed
Siegel 2015
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA: A Cancer Journal for Clinicians 2015;65(1):5‐29. - PubMed
Tierney 2007
    1. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time‐to‐event data into meta‐analysis. Trials 2007;8:16. - PMC - PubMed
Traverso 1980
    1. Traverso LW, Longmire WP Jr. Preservation of the pylorus in pancreaticoduodenectomy: a follow‐up evaluation. Annals of Surgery 1980;192(3):306‐10. - PMC - PubMed
Trede 1990
    1. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Annals of Surgery 1990;211(4):447‐58. - PMC - PubMed
Trede 1993
    1. Trede M, Carter DC. Surgery of the Pancreas. New York: Churchill Livingstone, 1993.
Watson 1944
    1. Watson K. Carcinoma of the ampulla of Vater. Successful radical resection. British Journal of Surgery 1944;31:368‐73.
Wente 2007a
    1. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007;142(1):20‐5. - PubMed
Wente 2007b
    1. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142(5):761‐8. - PubMed
Whipple 1935
    1. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Annals of Surgery 1935;102:763‐79. - PMC - PubMed
Williamson 1993
    1. Williamson RC, Bliouras N, Cooper MJ, Davies ER. Gastric emptying and enterogastric reflux after conservative and conventional pancreatoduodenectomy. Surgery 1993;114(1):82‐6. - PubMed
Yeo 1997
    1. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Annals of Surgery 1997;226(3):248‐57. - PMC - PubMed

References to other published versions of this review

Diener 2007
    1. Diener MK, Knaebel HP, Heukaufer C, Antes G, Buchler MW, Seiler CM. A systematic review and meta‐analysis of pylorus‐preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Annals of Surgery 2007;245(2):187‐200. - PMC - PubMed
Diener 2008
    1. Diener MK, Heukaeufer C, Schwarzer G, Seiler CM, Antes G, Knaebel H‐P, et al. Pancreaticoduodenectomy (classic Whipple) versus pylorus‐preserving pancreaticoduodenectomy (pp Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD006053.pub2] - DOI - PubMed
Diener 2011
    1. Diener MK, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, Knaebel HP, et al. Pylorus‐preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database of Systematic Reviews 2011, Issue 5. [DOI: 10.1002/14651858.CD006053.pub4] - DOI - PubMed
Diener 2014
    1. Diener MK, Fitzmaurice C, Schwarzer G, Seiler CM, Hüttner FJ, Antes G, et al. Pylorus‐preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD006053.pub5] - DOI - PMC - PubMed

MeSH terms