Pancreaticogastrostomy is Superior to Pancreaticojejunostomy for Prevention of Pancreatic Fistula after Pancreaticoduodenectomy: an Updated Meta-Analysis of Randomized Controlled Trials

ALVES A | LUBRANO J | MENAHEM B | GUITTET L | MULLIRI A

Séance du mercredi 25 février 2015 (SÉANCE FRANCO-CHINOISE)

Résumé

AbstractPancreatic fistula remains the Achilles’ heel after pancreaticoduodenectomy (PD). Previous studies comparing reconstruction by PG and PJ reported conflicting results regarding the relative risks of mortality and pancreatic fistula after these procedures.Medline, the Cochrane Trials Register, and EMBASE were searched for prospective randomized controlled trials comparing PG and PJ after PD, published up to November 2013. Meta-analysis was performed using Review Manager 5.0.Seven trials were selected, including 562 patients who underwent PG and 559 who underwent PJ. The pancreatic fistula rate was significantly lower in the PG group than in the PJ group [63/562, 11.2% vs 84/559, 18.7%; odds ratio (OR) = 0.53; 95% confidence interval (CI), 0.38–0.75; P = 0.0003]. The overall mortality rate was 3.7% (18/489) in the PG group and 3.9 % (19/487) in the PJ group (P = 0.68).In PD, reconstruction by PG is associated with lower postoperative pancreatic and biliary fistula rates.Commentateur: Shu You PENG