Meta-analysis Of Pancreaticogastrostomy And Pancreaticojejunostomy After Pancreaticoduodenectomy

Objective:To evaluate the efficacy of pancreaticogastrostomy or pancreaticojejunostomy after pancreaticoduodenectomy.Methods:Using Pub Med, EMBASE, The Cochrane Library databases, China Biology Medicine database(CBM) and China Knowledge Resource Integrated Database(CNKI), a systematic literature review was performed to identify randomized controlled trials comparing pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy. According to the inclusion and exclusion criteria, we included the literatures that met the evaluation criteria. We then evaluated the articles in bias risk assessment, quality, level of evidence, publication bias, and extracted the research data. Meta analysis was performed with Rev Man 5.2 software.Results:Seven trials including 1121 patients met the inclusion criteria(559 patients in pancreaticojejunostomy and 562 patients in pancreaticogastrostomy). The results shows that: 1.pancreaticogastrostomy could significantly reduce the rate of total pancreatic fistula(OR 1.70, 95%CI: 1.22-2.35, P=0.002). The result was the same when we analysed the subgroup of high-risk patients(OR 2.55, 95%CI: 1.30-5.01, P=0.006), the level of evidence for this result was moderate. 2.the rate of intra-abdominal collection after pancreaticogastrostomy was statistically lower than pancreaticojejunostomy(OR 2.33, 95%CI: 1.53-3.56, P<0.0001). 3.pancreaticogastrostomy could significantly shorten length of hospital stay(SMD 1.00, 95%CI: 0.34-1.65, P=0.003). Considering the existing high heterogeneity, the level of evidence was very low. 4.There was no statistically difference in delayed gastric emptying between two groups(OR 1.02, 95%CI: 0.55-1.89, P=0.95). However, when we analysed the articles according to the same definition of delayed gastric emptying, the result favored the pancreaticojejunostomy group(OR 0.60, 95%CI: 0.38-0.96, P=0.03), and the level of evidence was moderate. 5.There was no difference regarding overall complications between two groups(OR 1.14, 95%CI: 0.84-1.57, P=0.40). We still detected moderate heterogeneity in this result(I2=30%), we conducted the sensitivity analysis to find that the type of pancreaticogastrostomy, using stents or not and application of somatostatin analogue or not contributed to the heterogeneity. 6.We detected no significant difference in hemorrhage or mortality between two groups.Conclusion:Based upon this meta-analysis, pancreaticogastrostomy can significantly reduce the rate of pancreatic fistula and intra-abdominal collection, and shorten length of hospital stay, but with the risk of increasing the rate of delayed gastric emptying. However, given existing clinical and methodological heterogeneity, further high qualified randomized controlled trials comparing pancreaticogastrostomy with pancreaticojejunostomy on the basis of well-defined outcome parameters and optimal interventions are necessary to ensure this result.