| 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 |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
Markus K Diener; Christina Fitzmaurice; Guido Schwarzer; Christoph M Seiler; Gerd Antes; Hanns-Peter Knaebel; Markus W Büchler |
Related Documents
:
|
21573998 - Herniography influences the management of patients with suspected occult herniae and pa... 22031518 - High-dose insulin therapy reduces postoperative liver dysfunction and complications in ... 21802628 - Nepalese patients' anxiety and concerns before surgery. 9481068 - Intermittent intussusception caused by colonic lipoma. 21524008 - [reconstruction of the columella and the tip of the nose with an island-shaped forehead... 6581128 - Conservative management of degenerative temporomandibular joint disease in the elderly. |
Publication Detail:
|
Type: Journal Article; Meta-Analysis; Review Date: 2011-05-11 |
Journal Detail:
|
Title: Cochrane database of systematic reviews (Online) 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: 2011-08-11 |
Medline Journal Info:
|
Nlm Unique ID: 100909747 Medline TA: Cochrane Database Syst Rev Country: England |
Other Details:
|
Languages: eng Pagination: CD006053 Citation Subset: IM |
Affiliation:
|
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 10, Heidelberg, Germany, 69120. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Ampulla of Vater
/
surgery* Common Bile Duct Neoplasms / mortality, surgery* Gastric Emptying Humans Pancreatic Fistula / etiology Pancreatic Neoplasms / mortality, surgery* Pancreaticoduodenectomy / adverse effects, methods*, mortality Pylorus / surgery* Quality of Life Randomized Controlled Trials as Topic |
| Comments/Corrections | |
Update Of:
|
Cochrane Database Syst Rev. 2011;(2):CD006053
[PMID:
21328281
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: WITHDRAWN: Exercise for treating anterior cruciate ligament injuries in combination with collateral ...
Next Document: Exercise for vasomotor menopausal symptoms.