Postoperative Complications Of Different Pancreatic Anastomosis In Pancreatoduodenectomy:A Network Meta-analysis

Objective :To evaluate the incidence,safety and feasibility of postoperative complications in pancreaticoduodenectomy with different reconstruction methods of pancreatic anastomosis by Network Meta-Analysis.Methods:The databases of Pub Med,The Cochrane Library,Web of Science,EMBAS,CNKI,Wan Fang-CSPD,CQVIP and CBM were searched by computer.Chinese and English literatures related to the reconstruction of pancreatic anastomosis in pancreatoduodenectomy were retrieved,and relevant literatures were screened out according to the established inclusion and exclusion criteria.The literature quality was evaluated,and the relevant data of each RCT literature was extracted.Finally,the data extracted in this study were analyzed getting through Addis 16.6 software.The main analysis indexes were POPF,and the secondary analysis indexes were DGE,PPH,operative time and postoperative length of stay.Results :20 articles related to RCT were brought in,with a total of 2814 patients,and different reconstruction methods of pancreatic anastomosis in 8 PD were compared directly and indirectly.There are 613 patients in PJ E-S Inv group,955 patients in PJ E-S DTM group,218 patients in PJ E-S SL group,156 patients in PJ E-E Inv group,159 patients in BPJ group,577 patients in PG E-S Inv group,53 patients in PG E-S DTM group and 83 patients in BPG group.Getting through ADDIS16.6 software,NMA results in pancreaticoduodenectomy showed that: 1.BPG is 76% of the results of the reconstruction of the pancreatic anastomosis with the lowest POPF incidence,and 58% of the results of the reconstruction of the pancreatic anastomosis with the shortest operation time.2.PGE-SDTM is the method with the lowest incidence of PPH,with a ranking probability of 36%,PG E-S DTM was the method with the lowest incidence of DGE,with a ranking probability of 67%,and PG E-S DTM was the method with the shortest postoperative length of stay,with a ranking probability of 93%.3.In PJ,BPJ was the reconstruction method with the lowest POPF incidence,and the result ordering probability of 75%.PJ E-E Inv was the shortest method of pancreatic anastomosis with a ranking probability of 32%.PJ E-S DTM was the method of pancreatic anastomosis with the lowest incidence of PPH,with a ranking probability of 29%.PJ E-S SL was the method of pancreatic anastomosis with the lowest incidence of DGE,and the result ordering probability of 37%.PJ E-S DTM is the shortest postoperative length of stay of the pancreatic anastomosis method with a ranking probability of 70%.Conclusion:In pancreaticoduodenectomy: 1.BPG is the reconstruction method of pancreatic anastomosis with the lowest incidence of POPF and the shortest operation time.2.PG E-S DTM is the reconstruction method of pancreatic anastomosis with the lowest incidence of PPH,the lowest incidence of DGE and the shortest postoperative length of stay.3.Among PJ,BPJ is the reconstruction method with the lowest incidence of POPF,PJ E-E Inv is the reconstruction method with the shortest operation time,PJ E-S DTM is the lowest incidence of PPH and the shortest postoperative length of stay,and PJ E-S SL is the lowest incidence of DGE.