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Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis.
Ann Surg. 2008 Jun; 247(6):950-61.AnnS

Abstract

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.

Authors+Show Affiliations

Department of General, Visceral and Trauma Surgery, University of Heidelberg, Heidelberg, Germany. Markus.Buechler@med.uni-heidelberg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

18520222

Citation

Diener, Markus K., et al. "Duodenum-preserving Pancreatic Head Resection Versus Pancreatoduodenectomy for Surgical Treatment of Chronic Pancreatitis: a Systematic Review and Meta-analysis." Annals of Surgery, vol. 247, no. 6, 2008, pp. 950-61.
Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg. 2008;247(6):950-61.
Diener, M. K., Rahbari, N. N., Fischer, L., Antes, G., Büchler, M. W., & Seiler, C. M. (2008). Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Annals of Surgery, 247(6), 950-61. https://doi.org/10.1097/SLA.0b013e3181724ee7
Diener MK, et al. Duodenum-preserving Pancreatic Head Resection Versus Pancreatoduodenectomy for Surgical Treatment of Chronic Pancreatitis: a Systematic Review and Meta-analysis. Ann Surg. 2008;247(6):950-61. PubMed PMID: 18520222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. AU - Diener,Markus K, AU - Rahbari,Nuh N, AU - Fischer,Lars, AU - Antes,Gerd, AU - Büchler,Markus W, AU - Seiler,Christoph M, PY - 2008/6/4/pubmed PY - 2008/6/27/medline PY - 2008/6/4/entrez SP - 950 EP - 61 JF - Annals of surgery JO - Ann. Surg. VL - 247 IS - 6 N2 - 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. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/18520222/Duodenum_preserving_pancreatic_head_resection_versus_pancreatoduodenectomy_for_surgical_treatment_of_chronic_pancreatitis:_a_systematic_review_and_meta_analysis_ L2 - http://Insights.ovid.com/pubmed?pmid=18520222 DB - PRIME DP - Unbound Medicine ER -