| Aim: To compare outcomes between pancreaticoduodenectomy(PD) and pylorus-preserving pancreaticoduodenectomy(PPPD) for patients with periampullary and pancreatic carcinoma across all published comparative studies. Methods: Performed a search (Cochrane library, Medline, Embase, Premedline(ovid), Biosis, Journals Ovid, CBM) systematic to identify all eligible articles. Randomized controlled trials (RCTs) comparing PPPD versus PD for periampullary and pancreatic carcinoma were eligible for this SR(systematic review). Quantitative data on perioperative parameters (blood loss, operation time), mortality, morbidity, and survival were extracted from included studies for meta-analysis. Pooled estimates of overall treatment effect were calculated using a random effects model with significance reported at the 5% level. The quality of included studies was evaluated independently by 2 authors. Results: In total, 2421 abstracts were retrieved and checked for eligibility and 5 RCTs finally included. The comparison of overall in-hospital mortality (OR=0.49, 95% CI, 0.17 to 1.40; P=0.18), morbidity(OR=0.580, 95%CI=0.309,1.087, P=0.089), and 1 year survival(OR=1.279, 95%CI=0.667,2.450, P=0.459), 2 year survival (OR=1.420, 95%CI=0.633,3.186, P=0.395), 3 year survival (OR=1.235, 95%CI=0.621,2.453, P=0.548), DGE (OR=2.000, 95%CI=0.554,7.219, P=0.290)showed no significant difference. However, operating time (WMD=-1.444minutes, 95%CI=-2.462min,-0.425min, P=0.005), and intraoperative blood loss(WMD=-2.887, 95%CI=-3.871,-1.882L, P<0.05) were significantly reduced in the PPPD group. Conclusions: Both PD and PPPD had similar perioperative adverse events and survival rate, however, in overall analysis PPPD has lower operating time and intraoperative blood loss. Given obvious clinical and methodological interstudy heterogeneity, more high quality RCTs should be performed and unified outcome parameters should be defined. |
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