The pylorus: Take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer

Paul J. Karanicolas, Edward Davies, Regina Kunz, Matthias Briel, H. Pavan Koka, Darrin M. Payne, Shona E. Smith, Hui-Ping Hsu, Pin Wen Lin, Christian Bloechle, Karl Joseph Paquet, Gordon H. Guyatt

Research output: Contribution to journalReview article

62 Citations (Scopus)

Abstract

Background: Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer. Methods: We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. Results: Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53-92), with 284 mL less blood loss (P < .001, 95% CI, 176-391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25-1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. Conclusions: Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.

Original languageEnglish
Pages (from-to)1825-1834
Number of pages10
JournalAnnals of Surgical Oncology
Volume14
Issue number6
DOIs
Publication statusPublished - 2007 Jun 1

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Pancreaticoduodenectomy
Pylorus
Meta-Analysis
Confidence Intervals
Neoplasms
Bibliographic Databases
Textbooks
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Karanicolas, Paul J. ; Davies, Edward ; Kunz, Regina ; Briel, Matthias ; Koka, H. Pavan ; Payne, Darrin M. ; Smith, Shona E. ; Hsu, Hui-Ping ; Lin, Pin Wen ; Bloechle, Christian ; Paquet, Karl Joseph ; Guyatt, Gordon H. / The pylorus : Take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer. In: Annals of Surgical Oncology. 2007 ; Vol. 14, No. 6. pp. 1825-1834.
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title = "The pylorus: Take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer",
abstract = "Background: Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer. Methods: We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. Results: Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95{\%} confidence interval [95{\%} CI], 53-92), with 284 mL less blood loss (P < .001, 95{\%} CI, 176-391) and .66 fewer units of blood transfused (P = .002, 95{\%} CI, .25-1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. Conclusions: Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.",
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The pylorus : Take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer. / Karanicolas, Paul J.; Davies, Edward; Kunz, Regina; Briel, Matthias; Koka, H. Pavan; Payne, Darrin M.; Smith, Shona E.; Hsu, Hui-Ping; Lin, Pin Wen; Bloechle, Christian; Paquet, Karl Joseph; Guyatt, Gordon H.

In: Annals of Surgical Oncology, Vol. 14, No. 6, 01.06.2007, p. 1825-1834.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The pylorus

T2 - Take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer

AU - Karanicolas, Paul J.

AU - Davies, Edward

AU - Kunz, Regina

AU - Briel, Matthias

AU - Koka, H. Pavan

AU - Payne, Darrin M.

AU - Smith, Shona E.

AU - Hsu, Hui-Ping

AU - Lin, Pin Wen

AU - Bloechle, Christian

AU - Paquet, Karl Joseph

AU - Guyatt, Gordon H.

PY - 2007/6/1

Y1 - 2007/6/1

N2 - Background: Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer. Methods: We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. Results: Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53-92), with 284 mL less blood loss (P < .001, 95% CI, 176-391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25-1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. Conclusions: Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.

AB - Background: Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer. Methods: We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. Results: Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53-92), with 284 mL less blood loss (P < .001, 95% CI, 176-391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25-1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. Conclusions: Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.

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