A web-based overview, systematic review and meta-analysis of pancreatic anastomosis techniques following pancreatoduodenectomy
| Autor: | Lois A. Daamen, F.J. Smits, I. Q. Molenaar, Marc G. Besselink, O.R.C. Busch, Borel Rinkes Ih, van Santvoort Hc |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Treatment outcome 030230 surgery Anastomosis Pancreatic surgery law.invention Pancreaticoduodenectomy 03 medical and health sciences Pancreatic Fistula Young Adult 0302 clinical medicine Randomized controlled trial law Risk Factors Pancreaticojejunostomy medicine Humans Child Aged Randomized Controlled Trials as Topic Aged 80 and over Hepatology business.industry Incidence (epidemiology) Incidence Significant difference Gastroenterology Middle Aged medicine.disease Surgery Treatment Outcome Pancreatic fistula 030220 oncology & carcinogenesis Meta-analysis Female business |
| Zdroj: | HPB : the official journal of the International Hepato Pancreato Biliary Association. 20(9) |
| ISSN: | 1477-2574 |
| Popis: | Background Many pancreatic anastomoses have been proposed to reduce the incidence of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, but a complete overview is lacking. This systematic review and meta-analysis aims to provide an online overview of all pancreatic anastomosis techniques and to evaluate the incidence of clinically relevant POPF in randomized controlled trials (RCTs). Methods A literature search was performed to December 2017. Included were studies giving a detailed description of the pancreatic anastomosis after open pancreatoduodenectomy and RCTs comparing techniques for the incidence of POPF (International Study Group of Pancreatic Surgery [ISGPS] Grade B/C). Meta-analyses were performed using a random-effects model. Results A total of 61 different anastomoses were found and summarized in 19 subgroups ( www.pancreatic-anastomosis.com ). In 6 RCTs, the POPF rate was 12% after pancreaticogastrostomy (n = 69/555) versus 20% after pancreaticojejunostomy (n = 106/531) (RR0.59; 95%CI 0.35–1.01, P = 0.05). Six RCTs comparing subtypes of pancreaticojejunostomy showed a pooled POPF rate of 10% (n = 109/1057). Duct-to-mucosa and invagination pancreaticojejunostomy showed similar results, respectively 14% (n = 39/278) versus 10% (n = 27/278) (RR1.40, 95%CI 0.47–4.15, P = 0.54). Conclusion The proposed online overview can be used as an interactive platform, for uniformity in reporting anastomotic techniques and for educational purposes. The meta-analysis showed no significant difference in POPF rate between pancreatic anastomosis techniques. |
| Databáze: | OpenAIRE |
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