Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a Metaanalysis of randomized controlled trials

Objective To evaluate and compare the clinical effectiveness of pancreaticogastrostomy(PG)versus pancreaticojejunostomy(PJ) after pancreaticoduodenectomy(PD). Methods The Cochrane Library(2014,5th issue), Pub Med(from Jan. 1978 to May 2014), EMBASE(from Jan. 1966 to May 2014), SCI(from Jan. 1961 to May 2014), Chinese Bio-medicine database(from Jan. 1978 to May 2014), Chinese Journal Full-text Database(from Jan. 1994 to May 2014), VIP database(from Jan. 1989 to May 2014) and Wanfang database(from Jan. 1998 to May 2014) were searched as well as websites of clinical trial registries and search engine Google were searched.Randomized controlled trials(RCTs) of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy were included. The quality of included trials was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version. The Cochrane Collaboration's software Rev Man 5.2was used for Meta-analysis. Results Seven RCTs totaling 1 121 patients were included in this Meta-analysis, of which 562 patients undergone PG and 559 patients undergone PJ after PD. Meta-analysis of seven RCTs revealed significant difference between PG and PJ regarding pancreatic fistula(RR=0.56; 95% CI: 0.41~0.75; P=0.0001),biliary fistula(RR=0.43; 95% CI: 0.19~0.95; P=0.04), the morbidity of multiple intra-abdominal complications(OR=0.26; 95% CI: 0.12~0.56; P=0.0007) and intra-abdominal fluid collection(OR=0.54; 95% CI: 0.38~0.77;P=0.0005). The differences in biliary fistula, overall postoperative complications, delayed gastric emptying and mortality were of no statistical significance. Conclusion Current RCTs suggest that PG is better than PJ forpancreatic reconstruction after PD.