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Duodenum-preserving Pancreatic Head Resection Versus Pancreatoduodenectomy for Surgical Treatment of Chronic Pancreatitis: A Systematic Review and Meta-analysis

Diener, Markus K. MD*; Rahbari, Nuh N. MD*; Fischer, Lars MD*; Antes, Gerd PhD; Büchler, Markus W. MD*; Seiler, Christoph M. MD*

doi: 10.1097/SLA.0b013e3181724ee7

Objective: The optimal choice of technique for the surgical treatment of pancreatic head lesions in chronic pancreatitis is still under debate. This systematic review and meta-analysis aims to compare the effectiveness and safety of duodenum-preserving pancreatic head resection (DPPHR) versus pancreatoduodenectomy (PD) by means of parameters of mortality and morbidity and functional outcomes and quality of life.

Methods: A systematic literature search (Medline, Embase, Biosis, The Cochrane Library, and Science Citation Index) was performed to identify randomized controlled trials (RCTs) comparing DPPHR and PD. Included literature was assessed and extracted by 2 independent reviewers. A meta-analysis of pain relief (primary end point), several parameters of short- and long-term measures and quality of life, was done using the random effects-model.

Results: In total, 1284 citations were checked for eligibility and 4 RCTs were included. The critical appraisal revealed a heterogeneous methodological quality of included trials. Comparing DPPHR versus PD, postoperative pain relief, overall mortality, and morbidity showed no significant difference. Intraoperative blood replacement, hospital stay, weight gain, exocrine insufficiency, occupational rehabilitation, and quality of life were significantly improved in the DPPHR group.

Conclusion: DPPHR and PD seem to be equally effective in terms of postoperative pain relief, overall morbidity, and incidence of postoperative endocrine insufficiency. However, the presented findings suggest superiority of DPPHR in the treatment of chronic pancreatitis with regard to several peri and postoperative outcome parameters and quality of life. Further RCTs are eagerly awaited to prove these findings.

A systematic review and meta-analysis comparing duodenum-preserving pancreatic head resection versus pancreatoduodenectomy showed no difference in postoperative pain relief, overall mortality, and morbidity. The duodenum-preserving pancreatic head resection seems to be favorable regarding the need for intraoperative blood replacement, hospital stay, exocrine insufficiency, postoperative weight gain, occupational rehabilitation, and quality of life.

From the *Department of General, Visceral and Trauma Surgery, University of Heidelberg, Heidelberg, Germany; and †Institute of Medical Biometry and Medical Informatics, German Cochrane Center, University of Freiburg, Freiburg, Germany.

Reprints: Markus W. Büchler, MD, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.