Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-analysis of RCTs Applying the ISGPS (2016) Criteria

Abstract

The goal of our study was to compare the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on the incidence of complications after pancreaticoduodenectomy. A systematic search was performed using RevMan 5.3 software. A meta-analysis showed that PG was not superior to PJ in terms of postoperative pancreatic fistula (POPF). In multicenter randomized controlled trials, the incidence of POPF was lower in patients undergoing PG than in those undergoing PJ. However, PG was associated with an increased risk of postoperative intraluminal hemorrhage, but no significant difference was observed between 2-layer PG and PJ. No significant differences were found in the rate of overall delayed gastric emptying, biliary fistula, reoperation, mortality, and morbidity. PG and PJ have similar incidences of POPF, but PG could be slightly superior to PJ in multicenter trials. However, this analysis verifies that PG has a higher rate of postpancreatectomy hemorrhage. Of note, a 2-layer anastomosis could reduce the occurrence of postpancreatectomy hemorrhage.

FIGURE 1

Flow diagram of the published articles evaluated for inclusion in this meta-analysis.

FIGURE 2

Consensus risk of bias assessment of the included studies.

FIGURE 3

Forest plot of the meta-analysis comparing PG and PJ with regard to the incidence of POPF. CI indicates confidence interval; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy; POPF, postoperative pancreatic fistula.

FIGURE 4

Forest plot of the subgroup meta-analysis of the incidence of POPF according to the type of center (A and B); based on the type of PG (C and D); based on the type of PJ (E and F). CI indicates confidence interval; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy; POPF, postoperative pancreatic fistula.

FIGURE 5

Forest plot of the subgroup meta-analysis of the incidence of PPH (A); according to type of center (B and C); according to the type of PG (D and E). CI indicates confidence interval; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy; PPH, postpancreatectomy hemorrhage.

FIGURE 6

Forest plot of the subgroup meta-analysis of the incidence of DGE (A); bile fistula (B); mortality (C); morbidity (D) and reoperation (E). CI indicates confidence interval; DGE, delayed gastric emptying; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy.