Comparison Of Pancreatic Fistula Between Pancreaticogastrostomy And Pancreaticojejunostomy After Pancreaticoduodenectomy:A Meta Analysis

Objective:To evaluate and compare the difference of pancreatic fistula occurring in pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy.Methods:Clinical data(RCTs) of pancreatic fistula after panereatieoduodenectomy underwent pancreaticojejunostomy or pancreaticogastrostomy were collected from computer literature searching which was carried out in Pub Med、MEDLINE、BIOSIS Previews、Science Direct、Wan Fang and VIP database etc. According to the inclusion and exclusion criteria, analysis after screening included in Meta RCT 11 documents,all literatures were evaluated and datas were extracted. Postoperative pancreatic leakage as the observation index. Review Manager 5.3 was used for statistic analysis. Chi-square test was used for the statistical heterogeneity. Statistic analysis was based on all data of literatures and the forest map were drawed. Qualitative data use the odds ratio(OR) and 95% confidence interval(CI) for statistical description,Publication bias was assessed by using a funnel plot. By changing the inclusion criteria, eliminating the low quality of the study, using different models for sensitivity analysis.Results:A total of thirteen randomized controlled trails literature were chosen. Eleven studys including 1618 patients,825 in the pancreaticogastrostomy group and 793 in the pancreaticojejunostomy group. A Meta-analysis revealed that the incidence of pancreatic fistual was significantly lower in the PG group than in the PJ group(total OR 0.58,CI:0.40~0.83,P=0.003).Conclusion:PG seemed to be superior to PJ in reducing the incidenc of PF after PD. But there was a possibility of publication bias, selection bias, and bias in the study,which lead to the result of the combined distortion,so the results still need large sample, multi center prospective RCT study on verification.