Reconstruction methods of digestive tract after pancreaticodudenectomy: a systematic review and meta-analysis of RCTs / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate different types of anastomosis and reconstruction techniques after pancreaticodudenectomy with meat-analysis.</p><p><b>METHODS</b>Systematically literature search was performed through Wanfang, PubMed, EMBASE, Web of Science and Cochrane Library database without restriction to regions, publication types, or languages. A total of 17 randomized controlled trials met the criteria and were evaluated by Jadad scale. Fixed and random-effects models were used to measure the pooled estimates, including pancreatic fistula, bile leakage, hemorrhage, delay gastric emptying(DGE), mortality, reoperation.</p><p><b>RESULTS</b>Meta analysis revealed that patients undergoing pancreaticogastrostomy had a lower incidence of pancreatic fistula and bile leakage(OR=0.60, 95%CI:0.44-0.82, P=0.001; OR=0.33, 95%CI:0.13-0.82, P=0.02) as compared to pancreaticojejunostomy. In pancreaticoenterostomy group, pancreatic duct-mucosa pancreaticoenterostomy had no significant differences with traditional end-to-end anastomosis in terms of overall postoperative morbidity, and development of postoperative pancreatic fistula, reoperation, perioperative death. External stent placement drainage group had a lower postoperative overall complication rate and incidence of pancreatic fistula, especially the II(-III( grade pancreatic fistula, and a shorter hospital stay than non-stent drainage group(all P<0.05).</p><p><b>CONCLUSIONS</b>Pancreaticogastrostomy should be recommended as digestive tract reconstruction after pancreaticodudenectomy and assistant external stent drainage is also necessary.</p>

Perioperative safety of minimally invasive and open pancreaticoduodenectomy: a Meta analysis / 中华消化外科杂志

Objective To evaluate the perioperative safety of minimally invasive and open pancreaticoduodenectomy (PD).Methods The China National Knowledge Infrastructure,VIP,PubMed,The Cochrane Library and EMBASE were searched with the key words of laparoscopic,laparoscopy,robotic,da Vinci,minimally invasive,pancreaticoduodenectomy,微创,腹腔境,机器人,胰十二指肠切除术 to retrieve literatures on minimally invasive and open pancreaticoduodenectomy.All the patients were divided into the minimally invasive PD group and the open PD group,and the patients in the minimally invasive PD group were further divided into the robotic PD group and the laparoscopic PD group.A meta analysis was carried out using the RevMan 5.2 software.The count data were represented by the odds ratio (OR) and 95％ confidence interval (95％ CI),and the measurement data were represented by the weighted mean difference (WMD) and 95 ％ CI.Heterogeneity of the publication was analyzed using chi-square test,and the publication bias was analyzed using the funnel plots.The stability of results was analyzed using the sensitivity analysis.Results Ten literatures including 690 patients were selected.There were 235 patients in the minimally invasive PD group,and 455 in the open PD group; 107 patients were in the robotic PD group and 128 in the laparoscopic PD group.There were no significant difference in the incidence of postoperative complications,pancreatic fistula,delayed gastric emptying,postoperative hemorrhage,bile leakage,reoperation,mortality and number of lymph nodes dissected between the minimally invasive PD group and the open PD group (OR =0.75,1.01,0.98,1.50,0.94,0.56,1.06,WMD =2.29,95％ CI:0.40-1.41,0.67-1.53,0.55-1.77,0.76-2.94,0.37-2.38,0.26-1.20,0.48-2.32,-0.55-5.13,P ＞ 0.05).Although the operation time of the minimally invasive PD group was significantly longer than the open PD group,lesser volume of blood loss,shorter duration of postoperative hospital stay and higher R0 resection rate was detected in the minimally invasive PD group (WMD =99.57,-355.70,-3.30,OR =0.49,95％ CI:36.99-162.15,-608.38--103.01,-6.58-0.03,0.26-0.92,P ＜ 0.05).The operation time of the laparoscopic PD group was significantly longer than that of the open PD group (WMD =93.17,95％ CI:55.98-130.37,P ＜ 0.05).The operation time of the robotic PD group was comparable to that of the open PD group (WMD =122.96,95％ CI:-48.48-294.40,P ＞ 0.05).There was no significant difference in the duration of postoperative hospital stay between the laparoscopic PD group and the open PD group (WMD =-0.81,95％ CI:-5.08-3.45,P ＞ 0.05).The operation time of the robotic PD group was significantly shorter than that of the open PD group (WMD=-6.82,95％CI:-13.21--0.44,P＜0.05).Conclusions The perioperative safety of minimally invasive PD was comparable to open PD.Minimally invasive PD has the advantages of lesser blood loss and quick recovery of patients.Robotic PD could significantly decrease the operation time.Minimally invasive PD could be a reasonable alternative when the requirement of indications is fulfilled.