Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy

A review article and meta-analysis of randomized controlled trials

Abstract

Pancreatic fistula is one of the most feared complications after pancreaticoduodenectomy (PD). Results of randomized controlled trials comparing pancreaticogastric anastomosis with pancreaticojejunal anastomosis are not consistent. Furthermore, soft texture of pancreas is an established risk factor for postoperative pancreatic fistula (POPF). There has been no meta-analysis to date to compare pancreaticogastrostomy versus pancreaticojejunostomy in patients with intraoperative soft texture of pancreas. Hence, our primary objective was to determine the role of pancreaticogastrostomy compared to pancreaticojejunostomy after PD in prevention of POPF, especially in patients with soft pancreatic texture. We conducted meta-analysis of randomized controlled trials that had compared pancreaticojejunal anastomosis with pancreaticogastric anastomosis after PD, and pancreatic fistula was among the outcome variables. Ten randomized controlled trials were included in the meta-analysis which comprised of a total of 1629 patients, of which 803 underwent pancreaticojejunostomy, whereas 826 were in the pancreaticogastrostomy group. There was no difference in clinically relevant POPF (CR-POPF) rate in pancreaticojejunostomy versus pancreaticogastrostomy (19.8% vs. 12.8%, P = 0.09) group. POPF rate in patients with soft pancreas was significantly more in pancreaticojejunostomy group as compared to pancreaticogastrostomy group (25.4% vs. 17.3%, odds ratio = 1.71, 95% confidence interval = 1.15–2.53, P = 0.008). Although there is no difference in pancreaticogastrostomy as compared to pancreaticojejunostomy after PD to prevent CR POPF, in a subgroup of high-risk patients with soft pancreatic texture pancreaticogastrostomy has favorable results.