Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2019; 11(7): 322-332
Published online Jul 27, 2019. doi: 10.4240/wjgs.v11.i7.322
Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: An updated meta-analysis of RCTs and our experience
Yun Jin, Yang-Yang Feng, Xiao-Gang Qi, Geng Hao, Yuan-Quan Yu, Jiang-Tao Li, Shu-You Peng
Yun Jin, Yang-Yang Feng, Xiao-Gang Qi, Geng Hao, Yuan-Quan Yu, Jiang-Tao Li, Shu-You Peng, Department of General Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Author contributions: Li JT and Peng SY conceived and designed the study; Jin Y, Feng YY, and Hao G performed data extraction and statistical analysis; Jin Y, Feng YY, and Qi XG wrote the paper; Yu YQ, Li JT, and Peng SY reviewed and edited the manuscript; all authors read and approved the manuscript.
Supported by Training Project of Health High Level Talents in Zhejiang Province (2014).
Conflict-of-interest statement: We declare that we have no conflict of interest to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jiang-Tao Li, FACS, MD, Attending Doctor, Department of General Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, Zhejiang Province, China. zrljt@zju.edu.cn
Telephone: +86-571-89713729
Received: April 16, 2019
Peer-review started: April 19, 2019
First decision: June 3, 2019
Revised: June 11, 2019
Accepted: June 20, 2019
Article in press: June 21, 2019
Published online: July 27, 2019
Processing time: 102 Days and 20.5 Hours
ARTICLE HIGHLIGHTS
Research background

Pancreatoduodenectomy (PD) is one of the most important operations in hepatobiliary and pancreatic surgery. Pancreatico-digestive tract reconstruction includes pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Unlike gastrointestinal anastomosis, these two types of reconstruction after pancreatic surgery are diverse, with different results and evaluations. Therefore, there is still room for improvement in PJ and PG, and these procedures are still the focus of future research in PD.

Research motivation and objectives

This systematic and meta-analysis aimed to evaluate the role and importance of pancreatico-digestive tract anastomosis. Advantages and disadvantages of PJ and PG were compared to provide a valuable reference and safe choice in the future.

Research methods

This search was applied to Medline, Wanfang Data, Embase, Science Citation Index Expanded, and the Cochrane Library. The last search was run on March 15, 2019. All clinical randomized controlled trials, in which patients underwent PD with pancreatico-digestive tract reconstruction via PJ or PG, were included. The Chi-square test was used to test heterogeneity among studies. The heterogeneity level was judged according to I2. Relative risk (RR), weighted mean difference (WMD), standardized mean difference (SMD), and 95%CI were used.

Research results

In the meta-analysis of postoperative hemorrhage, there was no significant heterogeneity between these studies (I2 = 0%); accordingly, a fixed-effect model was applied. Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group (OR = 1.47, 95%CI: 1.05-2.06, P = 0.03). In the meta-analysis of DGE, there was no significant heterogeneity between these studies (I2 = 47%), and therefore a fixed-effects model was applied. DGE was not significantly different between the two groups (OR = 1.09, 95%CI: 0.83-1.41, P = 0.54).

Research conclusions

Our group has studied the anastomosis of the pancreas and digestive tract for more than 20 years, and has accumulated some experiences. We established the binding pancreaticoje-junostomy (BPJ) and binding pancreaticogastrostomy (BPG). The mid-term results of the randomized controlled study showed that the incidence of PF in BPG and BPJ was acceptable.

Research perspectives

Laparoscopic pancreaticogastrointestinal anastomosis has become a new focus for research. The objective of evaluation should be as simple as possible. Moreover, the lower the incidence of pancreatic leakage compared with classical anastomosis, the better. As long as these principles are followed, sample enlargement and randomized controlled trials should be conducted to find the best method.