Document Detail

Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma.
MedLine Citation:
PMID:  21563148     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer death for men and the fifth for women. The standard treatment for resectable tumours is either a classic Whipple (CW) operation or a pylorus-preserving pancreaticoduodenectomy (PPW). It is unclear which of the procedures is more favourable in terms of survival, mortality, complications and quality of life.
OBJECTIVES: The objective of this systematic review is to compare the effectiveness of each operation.
SEARCH STRATEGY: We conducted searches on 28 March 2006 and 11 January 2011 to identify all randomised controlled trials (RCTs), applying no language restrictions. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), CDSR and DARE from The Cochrane Library (2010, Issue 4), MEDLINE (1966 to January 2011), and EMBASE (1980 to January 2011). Abstracts from Digestive Disease Week and U nited European Gastroenterology Week (1995 to 2010). No additional studies were indentified upon updating the systematic review in 2011.
SELECTION CRITERIA: We considered RCTs comparing the CW with PPW to be eligible if they included patients with periampullary or pancreatic carcinoma.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data from the included studies. We used a random-effects model for pooling data. We compared binary outcomes using odds ratios (OR), pooled continuous outcomes using mean differences (MD) and used hazard ratios (HR) for meta-analysis of survival. Two authors independently evaluated the methodological quality and risk of bias of the included studies according to Cochrane standards.
MAIN RESULTS: We included six randomised controlled trials with a total of 465 patients. Our critical appraisal revealed vast heterogeneity with respect to methodological quality and outcome parameters. In-hospital mortality (OR 0.49; 95% confidence interval (CI) 0.17 to 1.40; P = 0.18), overall survival (HR 0.84; 95% CI 0.61 to 1.16; P = 0.29) and morbidity showed no significant differences. However, we noted that operating time (MD -68.26 minutes; 95% CI -105.70 to -30.83; P = 0.0004) and intra-operative blood loss (MD -0.76 millilitres; 95% CI -0.96 to -0.56; P < 0.00001) were significantly reduced in the PPW group. All significant results have low quality of evidence based on GRADE criteria.
AUTHORS' CONCLUSIONS: There is no evidence of relevant differences in mortality, morbidity and survival between the two operations. Given obvious clinical and methodological heterogeneity, future research must be undertaken to perform high-quality randomised controlled trials of complex surgical interventions on the basis of well-defined outcome parameters.
Markus K Diener; Christina Fitzmaurice; Guido Schwarzer; Christoph M Seiler; Gerd Antes; Hanns-Peter Knaebel; Markus W Büchler
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2011-05-11
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2011  
Date Detail:
Created Date:  2011-05-12     Completed Date:  2011-06-23     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD006053     Citation Subset:  IM    
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 10, Heidelberg, Germany, 69120.
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MeSH Terms
Ampulla of Vater / surgery*
Common Bile Duct Neoplasms / mortality,  surgery*
Gastric Emptying
Pancreatic Fistula / etiology
Pancreatic Neoplasms / mortality,  surgery*
Pancreaticoduodenectomy / adverse effects,  methods*,  mortality
Pylorus / surgery*
Quality of Life
Randomized Controlled Trials as Topic
Update Of:
Cochrane Database Syst Rev. 2011;(2):CD006053   [PMID:  21328281 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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