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Meta-Analysis
. 2018 Oct;97(40):e12621.
doi: 10.1097/MD.0000000000012621.

Selection of pancreaticojejunostomy technique after pancreaticoduodenectomy: duct-to-mucosa anastomosis is not better than invagination anastomosis: A meta-analysis

Yunxiao Lyu  1 , Ting Li  2 , Bin Wang  1 , Yunxiao Cheng  1 , Sicong Zhao  1
Affiliations
Meta-Analysis

Selection of pancreaticojejunostomy technique after pancreaticoduodenectomy: duct-to-mucosa anastomosis is not better than invagination anastomosis: A meta-analysis

Yunxiao Lyu et al. Medicine (Baltimore). 2018 Oct.

Abstract

Background: One of the most clinically significant current discussions is the optimal pancreaticojejunostomy (PJ) technique for pancreaticoduodenectomy (PD). We performed a meta-analysis to compare duct-to-mucosa and invagination techniques for pancreatic anastomosis after PD.

Methods: A systematic search of PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov up to June 1, 2018 was performed. Randomized controlled trials (RCTs) comparing duct-to-mucosa versus invagination PJ were included. Statistical analysis was performed using RevMan 5.3 software.

Results: Eight RCTs involving 1099 patients were included in the meta-analysis. The rate of postoperative pancreatic fistula (POPF) was not significantly different between the duct-to-mucosa PJ (110/547, 20.10%) and invagination PJ (98/552, 17.75%) groups in all 8 studies (risk ratio, 1.13; 95% CI, 0.89-1.44; P = .31). The subgroup analysis using the International Study Group on Pancreatic Fistula criteria showed no significant difference in POPF between duct-to-mucosa PJ (97/372, 26.08%) and invagination PJ (78/377, 20.68%). No significant difference in clinically relevant POPF (CR-POPF) was found between the 2 groups (55/372 vs 40/377, P = .38). Additionally, no significant differences in delayed gastric emptying, post-pancreatectomy hemorrhage, reoperation, operation time, or length of stay were found between the 2 groups. The overall morbidity and mortality rates were not significantly different between the 2 groups.

Conclusion: The duct-to-mucosa technique seems no better than the invagination technique for pancreatic anastomosis after PD in terms of POPF, CR-POPF, and other main complications. Further studies on this topic are therefore recommended.

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Conflict of interest statement

All authors have declared that no competing interests exist. And all data and materials in this work were available from publications.

Figures

Figure 1
Figure 1
Flow diagram of the published articles evaluated for inclusion in this meta-analysis.
Figure 2
Figure 2
Consensus risk-of-bias assessment of the included studies. Green, low risk; yellow, unclear; red, high risk.
Figure 3
Figure 3
Forest plot of the meta-analysis comparing duct-to-mucosa PJ and invagination PJ with respect to (A) POPF, (B) CR-POPF, (C) DGE, (D) PPH, and (E) reoperation. CR-POPF = clinically relevant POPF, DGE = delayed gastric emptying, PJ = pancreaticojejunostomy, POPF = postoperative pancreatic fistula, PPH = post-pancreatectomy hemorrhage.
Figure 3 (Continued)
Figure 3 (Continued)
Forest plot of the meta-analysis comparing duct-to-mucosa PJ and invagination PJ with respect to (A) POPF, (B) CR-POPF, (C) DGE, (D) PPH, and (E) reoperation. CR-POPF = clinically relevant POPF, DGE = delayed gastric emptying, PJ = pancreaticojejunostomy, POPF = postoperative pancreatic fistula, PPH = post-pancreatectomy hemorrhage.
Figure 3 (Continued)
Figure 3 (Continued)
Forest plot of the meta-analysis comparing duct-to-mucosa PJ and invagination PJ with respect to (A) POPF, (B) CR-POPF, (C) DGE, (D) PPH, and (E) reoperation. CR-POPF = clinically relevant POPF, DGE = delayed gastric emptying, PJ = pancreaticojejunostomy, POPF = postoperative pancreatic fistula, PPH = post-pancreatectomy hemorrhage.
Figure 4
Figure 4
Forest plot of the meta-analysis comparing duct-to-mucosa PJ and invagination PJ with respect to the (A) operation time, (B) LOS, (C) morbidity, and (D) mortality. LOS = length of stay, PJ = pancreaticojejunostomy.
Figure 4 (Continued)
Figure 4 (Continued)
Forest plot of the meta-analysis comparing duct-to-mucosa PJ and invagination PJ with respect to the (A) operation time, (B) LOS, (C) morbidity, and (D) mortality. LOS = length of stay, PJ = pancreaticojejunostomy.
See this image and copyright information in PMC

References

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