PPPD Versus PD For Periampullary And Pancreatic Head Carcinoma: A Systematic Review

Objective:To evaluate the pylorus preserving pancreaticoduodenectomy (PPPD) Versus pancreaticoduodenectomy (PD) for Periampullary and pancreatic head carcinoma.Methods:we searched the cochrane library (issue 2,2010);PubMed (1978-2010); MEADLINE (1966.1-2010.8);Embase (1966.1-2010.8);CMB (1978.1-2010.8);VIP (1989.1-2010.8); CNKI (1989.1-2010.8);OVID (2000-2010.8). as well as hand searched several relateed journals and conference proceedings for the randomized controlled trials involving the comparison of the efficacy of the pylorus preserving pancreaticoduodenectomy (PPPD) Versus standard pancreaticoduodenectomy (PD) in patients with resectable Periampullary and pancreatic head carcinoma. Results:six studies involving 468 patients were identified studies. When comparing PPPD with PD, for treatment of resectable Periampullary and pancreatic head carcinoma, pylorus preserving pancreaticoduodenectomy (PPPD) Versus standard pancreaticoduodenectomy (PD) showed no statistical difference in postoperative complications [RR=0.86,95%CI (0.66,1.14), P=0.29];no statistical difference in Delayed gastric empting (used random effects in meta-analysis) [RR=1.30,95%CI (0.69,2.45), P=0.41];no statistical difference inl,2 and 3years survival rate [RR=1.20,95%CI (0.73,1.97), P=0.48];[RR=1.02, 95%CI (0.78,1.32), P=0.89];[RR=1.04,95%CI (0.89,1.21), P=0.65];have statistical difference in operation time as well as blood loss. [WMD= (-29.82),95% CI (-48.05)-(-11.59), P=0.001];[WMD= (-527.21),95%CI (-1044.05)-(-10.36), P=0.05].Conclusions:In conclusion pylorus preserving pancreaticoduodenectomy (PPPD) Versu-sstandard pancreaticoduodenectomy (PD) no differences in survival,postoperative complications. pylorus preserving pancreaticoduodenectomy(PPPD)have lesser operation time and blood loss than pancreaticoduodenectomy. Considering the small sample size and insurancet evidence was obtain in this systematic review. therefore, It is necessary to carry out further high-quality multi-center prospective randomized trials or systimatic review to determine the value of pylorus preserving pancreaticoduodenectomy with standard pancre- aticoduodenectomy for the disease of Periampullary and pancreatic hea-d carcinoma.