Meta-Analysis
Copyright ©The Author(s) 2015.
World J Gastroenterol. May 28, 2015; 21(20): 6361-6373
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6361
Table 1 Characteristics of the included studies
Ref.CountryYearDesignGroupnSex (M/F)Age1Benign/malignantQuality score
Hayashibe et al[17]Japan2007RetroPPPD124/860.9 ± 8.50/121 (McKay)
SSPPD218/1364.3 ± 9.51/20
Akizuki et al[27]Japan2008PNRPPPD3420/14 18/1266 (28-78)15/192 (McKay)
SSPPD3065 (39-79)4/26
Kurahara et al[28]Japan2010RetroPPPD4826/22 38/2664.418/301 (McKay)
SSPPD6466.811/53
Oida et al[30]Japan2011RetroPPPD2521/466.2 ± 4.70/251 (McKay)
SSPPD4230/1265.8 ± 5.80/42
Kawaiet al[29]Japan2011RCTPPPD6433/31 38/2868 ± 912/523 (Jadad)
SSPPD6667 ± 914/52
Fujii et al[31]Japan2012RetroPPPD3319/1463.8 (35-83)0/331 (McKay)
SSPPD5628/2864.6 (41-84)0/56
Nanashima et al[33]Japan2013RetroPPPD2821/768 ± 87/211 (McKay)
SSPPD2715/1266 ± 125/22
Matsumoto et al[35]Japan2014RCTPPPD5029/21 35/1566 ± 1018/323 (Jadad)
SSPPD5067 ± 921/29
Table 2 Surgical reconstruction, definition of delayed gastric emptying and postoperative management
Ref.ReconstructionDefinition of DGEIndication for removing NGTPPIPA
Hayashibe et al[17]Duct to mucosa and end-to-side pancreaticojejunostomy, end-to-side antecolic gastrojejunostomy, and side-to-side jejunojejunostomy (Braun anastomosis)(1) NGT ≥ POD 10UnknownUnknownUnknown
(2) inability to tolerate a solid diet ≥ POD 14
Akizuki et al[27]Duct-to-mucosa and end-to-side pancreaticojejunostomy,end duodenal (or stomach)-to-side jejunal, Braun anastomosis was made(1) NGT ≥ POD 10The fluid of NGT < 500 mL per night, generally removed on POD 1YesYes
(2) inability to tolerate a solid diet ≥ POD 14
Kurahara et al[28]End-to-side pancreaticogastrostomy with an internal stent, end-to-side duodenojejunostomy (PPPD) or gastrojejunostomy (SSPPD)ISGPSThe fluid of NGT < 500 mL per nightYesYes
Oida et al[30]Pancreaticogastrostomy and end to end duodenojejunostomy (PPPD)ISGPSUnknownUnknownUnknown
Pancreaticogastrostomy and end to end gastrojejunostomy (SSPPD)
Kawai et al[29]Duct-to-mucosa, end-to-side pancreatojejunostomy with internal stentISGPSAll removed on POD 1NoNo
Duodenojejunostomy (PPPD), gastrojejunostomy (SSPPD)
Fujii et al[31]End-to-side pancreatojejunostomy and end-to-side antecolic gastrojejunostomy in SSPPD or a duodenojejunostomy in PPPDISGPSGenerally removed on POD 1, or on POD 2 if the fluid of NGT > 500 mL per nightUnknownUnknown
Nanashima et al[33]End-to-side with external stent pancreatojejunostomyISGPSThe fluid of the NGT < 300 mL per nightYesUnknown
Matsumoto et al[35]End-to-side pancreatojejunostomy, end-to-side duodenojejunostomy (PPPD) and gastrojejunstomy (SSPPD)ISGPSThe fluid of the NGT < 200 mL per nightYesUnknown
Table 3 Summary results for studies comparing pylorus-preserving pancreaticoduodenectomy and subtotal stomach-preserving pancreaticoduodenectomy
Outcome of interestNo. ofstudiesNo. ofpatientsOR/WMD = (95%CI)P valueHeterogeneity P valueI2
Delayed gastric emptying86502.75 (1.75-4.30)< 0.000010.1043%
Operation time8650-5.30 (-43.44-32.84)0.790.000377%
Intraoperative blood loss8650-217.70 [-429.77-(-5.63)]0.040.00468%
Pancreatic fistula75830.91 (0.56-1.49)0.70.970%
Postoperative hemorrhage54610.51 (0.15-1.74)0.290.950%
Intra-abdominal abscess54611.05 (0.54-2.05)0.890.650%
Wound infection53940.88 (0.39-1.97)0.750.880%
Time of start liquid diet42862.97 (-0.43-6.38)0.090.00182%
Time of start solid diet43163.69 (-0.46-7.83)0.08< 0.0000191%
Time of nasogastric intubation64382.68 (0.77-4.58)0.006< 0.0000196%
Reinsertion of nasogastric tube43491.90 (0.91-3.97)0.090.580%
Mortality64710.31 (0.05-2.01)0.221.000%
Hospital stay42553.92 (-0.37-8.22)0.070.0464%
Table 4 Sensitivity analysis performed for studies comparing pylorus-preserving pancreaticoduodenectomy and subtotal stomach-preserving pancreaticoduodenectomy
Outcome of interestNo. of studiesNo. of patientsOR (95%CI)P valueHeterogeneityP valueI2
DGE with ISGPS definition
DGE (ISGPS B/C)65538.73 (2.09-36.56)0.003< 0.000182%
Operation time65536.50 (-35.02-48.02)0.760.000580%
Intraoperative blood loss65530.78 (-81.90-83.46)0.990.2033%
Pancreatic fistula54860.92 (0.54-1.55)0.750.930%
Postoperative hemorrhage43970.57 (0.15-2.16)0.410.910%
Intraabdominal abscess43971.07 (0.53-2.18)0.850.490%
Wound infection32971.18 (0.45-3.09)0.740.980%
Time of start liquid diet21893.62 (-2.82-10.06)0.270.0380%
Time of start solid diet32524.77 (-0.11-9.64)0.06< 0.0000194%
Time of nasogastric intubation43413.32 (0.31-6.32)0.03< 0.0000197%
Reinsertion of nasogastric tube32852.15 (0.93-4.96)0.070.440%
Mortality43740.32 (0.03-3.18)0.330.970%
Hospital stay32225.96 (3.46-8.46)< 0.000010.550%
DGE with other definition
DGE2972.29 (0.35-15.21)0.390.1161%
Operation time297-48.51 (-109. 22-12.20)0.120.790%
Intraoperative blood loss297-588.29 [-898.10-(-278.49)]0.00020.790%
Pancreatic fistula2970.86 (0.22-3.33)0.83--
Wound infection2970.44 (0.09-2.08)0.300.880%
Time of start liquid diet2972.30 (-2.30-6.91)0.330.00687%
Time of NGD insertion2971.82 (-2.43-6.06)0.400.02
Mortality2970.29 (0.01-7.26)0.45--
Hospital stay2970.17 (-2.77-3.11)0.910.2427%
Reconstruction with pancreaticojejunostomy
DGE64713.72 (2.12-6.56)< 0.000010.1835%
Operation time6471-11.79 (-32.26-8.68)0.260.2130%
Intraoperative blood loss6471-265.87 (-422.93-108.81)0.00090.1538%
Pancreatic fistula64710.90 (0.55-1.48)0.670.940%
Postoperative hemorrhage43490.61 (0.16-2.38)0.480.930%
Intra-abdominal abscess43491.06 (0.51-2.22)0.880.480%
Wound infection43270.83 (0.34-2.03)0.680.780%
Time of start solid diet32492.29 (-1.97-6.54)0.290.0664%
Time of nasogastric intubation53711.92 (0.38-3.47)0.01< 0.0000189%
Hospital stay31881.23 (-1.64-4.09)0.400.2528%
Reconstruction with pancreaticogastrostomy
DGE21791.51 (0.70-3.26)0.29--
Operation time217949.00 (30.41-67.59)< 0.00001--
Intraoperative blood loss217941.00 (-51.78-133.78)0.39--
Randomized controlled trial
DGE22302.69 (1.17-6.17)0.020.320%
Operation time2230-16.69 (-42.68-9.30)0.210.830%
Intraoperative blood loss2230-120.23 (-364.94-124.48)0.340.770%
Pancreatic fistula22301.08 (0.53-2.20)0.820.910%
Postoperative hemorrhage22300.67 (0.11-4.11)0.670.720%
Intra-abdominal abscess22300.75 (0.14-4.14)0.750.1551%
Wound infection22301.19 (0.38-3.70)0.760.860%
Reinsertion of nasogastric tube22302.17 (0.84-5.59)0.110.2039%
Mortality22300.34 (0.01-8.46)0.51--
Non-randomized controlled trial
DGE64203.36 (1.25-9.08)0.020.0558%
Operation time6420-0.56 (-47.55-46.43)0.980.00772%
Intraoperative blood loss6420-283.77 (-593.42-25.87)0.070.00178%
Pancreatic fistula53530.77 (0.39-1.53)0.460.930%
Postoperative hemorrhage32310.41 (0.08-2.22)0.300.780%
Intra-abdominal abscess32311.21 (0.47-3.13)0.700.830%
Wound infection31640.64 (0.19-2.08)0.450.730%
Time of start liquid diet31863.68 (-0.30, 7.66)0.070.000687%
Time of start solid diet31865.06 (0.39-9.73)0.030.0469%
Time of nasogastric intubation53083.49 (0.82-6.16)0.01< 0.0000195%
Hospital stay3155 4.28 (-0.56-9.12)0.080.0276%
Mortality42400.30 (0.03-2.94)0.300.970%
D1 lymph node dissection
DGE2570.32 (0.07-1.48)0.140.900%
D2 lymph node dissection
DGE21193.07 (1.05-9.02)0.040.530%