Document Detail

The pylorus: take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer.
MedLine Citation:
PMID:  17342566     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or periampullary cancer. METHODS: We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. RESULTS: Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53-92), with 284 mL less blood loss (P < .001, 95% CI, 176-391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25-1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. CONCLUSIONS: Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.
Paul J Karanicolas; Edward Davies; Regina Kunz; Matthias Briel; H Pavan Koka; Darrin M Payne; Shona E Smith; Hui-Ping Hsu; Pin-Wen Lin; Christian Bloechle; Karl-Joseph Paquet; Gordon H Guyatt
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2007-03-08
Journal Detail:
Title:  Annals of surgical oncology     Volume:  14     ISSN:  1068-9265     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-01     Completed Date:  2007-10-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1825-34     Citation Subset:  IM    
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main St. W, Hamilton, Ontario, L85 3Z5, Canada.
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MeSH Terms
Ampulla of Vater / surgery*
Blood Loss, Surgical
Blood Transfusion
Common Bile Duct Neoplasms / surgery*
Databases as Topic
Longitudinal Studies
Models, Statistical
Pancreatic Neoplasms / surgery*
Pancreaticoduodenectomy / methods*
Pylorus / surgery*
Randomized Controlled Trials as Topic
Survival Rate
Time Factors
Treatment Outcome

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

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