Eficacia de la resección pancreática con preservación duodenal versus pancreaticoduodenectomía en el tratamiento de la pancreatitis crónica en adultos: Revisión Sistemática y Meta-análisis
DOI:
https://doi.org/10.35434/rcmhnaaa.2022.15Supl.%201.1607Palabras clave:
Pancreatitis crónica, resección pancreática, preservación duodenal, eficaciaResumen
Introducción: Los estudios que comparan la resección pancreática con preservación duodenal (DPPHR) versus pancreaticoduodenectomía (PD) en el tratamiento de la pancreatitis crónica demuestran diferencias notables, sin embargo, la evidencia actual no es adecuada para establecer la superioridad de estos enfoques. Objetivo: Determinar si la resección pancreática con preservación duodenal es más eficaz que la pancreaticoduodenectomía en el tratamiento de la pancreatitis crónica en adultos. Material y métodos: Se realizó una revisión sistemática identificando y extrayendo datos de siete ensayos clínicos aleatorizados y siete estudios observacionales comparando la eficacia de la resección pancreática con preservación duodenal versus la pancreaticoduodenectomía. Resultados: La hemorragia tuvo una diferencia de medias (MD) de -0.18, IC al 95% de -0.25 – -0.12 y p < 0.00001. El tiempo operatorio tuvo una MD de -1.32, IC al 95% de -2.20 – -0.44 y p = 0.003. Estancia hospitalaria tuvo una MD de -3.94, IC al 95% de -6.16 – -1.71 y p = 0.0005. La insuficiencia endocrina tuvo RR de 0.78, IC al 95% de 0.65 – 0.95 y p = 0.01. Pain Score mostró una MD de -7.39, IC al 95% de -13.05 – -1.74 y p = 0.01. Calidad global de vida, mostró MD de 8.97, IC al 95% de 4.05 – 13.90 y p = 0.0004. Conclusiones: La DPPHR resulta más eficaz que la PD al disminuir el sangrado intraoperatorio, tiempo operatorio, estancia hospitalaria, el riesgo de insuficiencia endocrina y al proporcionar mejor alivio del dolor y calidad de vida.
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Gurusamy, K.S, Lusuku, C, Halkias, C. Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis. Cochrane Database of Systematic Reviews. 2016. doi: 10.1002/14651858.CD011521.pub2
Czul F, Coronel E, Donet JA. Una actualización de pancreatitis crónica: artículo de revisión. Rev Gastroenterol Perú. 2017; 37(2): 146-155. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1022-51292017000200007
Diener, M.K, Hüttner, F.J, Kieser, M, Knebel, P, Dörr-harim, C. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. The Lancet. 2017;390(10099): 1027-1037. doi: 10.1016/S0140-6736(17)31960-8.
Kempeneers, M.A, Issa, Y, Ali, U.A, Baron, R.D, Besselink, M.G. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology. 2020;20(2): 149-157. doi: 10.1016/j.pan.2019.12.005.
Belina F, Fronek J, Ryska M. Duodenopancreatectomy versus Duodenum-Preserving Pancreatic Head Excision for Chronic Pancreatitis. Pancreatology. 2005; (5): 547 - 552. doi: 10.1159/000087496.
Dua, M.M, Visser, B.C. Surgical Approaches to Chronic Pancreatitis: Indications and Techniques. Digestive Diseases and Sciences. 2017;62(7): 1738-1744. doi: 10.1007/s10620-017-4526-x.
Skube, M.E, G.J, Beilman. Surgical treatment of pain in chronic pancreatitis: Current Opinion in Gastroenterology. 2018;34(5): 317-321. doi: 10.1097/MOG.0000000000000460.
Bachmann K, Kutup A, Mann O, Yekebas E, Izbicki JR. Surgical treatment in chronic pancreatitis timing and type of procedure. Best Pract Res Clin Gastroenterol 2010;24(3): 299–310. doi: 10.1016/j.bpg.2010.03.003.
Strobel, O, Büchler, MW, Werner, J. Surgical therapy of chronic pancreatitis: Indications, techniques and results. International Journal of Surgery. 2009; (7): 305-312. doi: 10.1016/j.ijsu.2009.05.011.
Büchler MW, Friess H, Uhl W, Malfertheiner P. Chronic pancreatitis. Novel concepts in biology and therapy. Blackwell Science. 2002: 529–539.
Kelemen D, Horváth OP. Clinical Experience with Different Techniques of Pancreatic Head Resection for Chronic Pancreatitis. Did Surg. 2002; 19: 28 – 35. doi: 10.1159/000052002.
Zhao, X, Cui, N, Wang, X, Cui, Y. Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials. Medicine. 2017;96(9): e6220. doi: 10.1097/MD.0000000000006220.
Bachmann, K, Tomkoetter, L, Kutup, A, Erbes, J, Vashist, Y. Is the Whipple Procedure Harmful for Long-term Outcome in Treatment of Chronic Pancreatitis? 15-Years Follow-up Comparing the Outcome after Pylorus-Preserving Pancreatoduodenectomy and Frey Procedure in Chronic Pancreatitis. Annals of Surgery. 2013;258(5): 815-821. doi: 10.1097/SLA.0b013e3182a655a8.
Schäfer, M, Müllhaupt, B, Clavien, P.A. Evidence-Based Pancreatic Head Resection for Pancreatic Cancer and Chronic Pancreatitis. Ann Surg. 2002;236(2): 137-148. doi: 10.1097/00000658-200208000-00001.
Bockhorn M, Gebauer F, Bogoevski D, Molmenti E, Cataldegirmen G, Vashist Y et al. Chronic pancreatitis complicated by cavernous transformation of the portal vein: contraindication to surgery? Surgery 149:321–328, 2011. doi: 10.1016/j.surg.2010.06.011.
Aspelund, G, Topazian, M, Lee, J, Andersen, D. Improved Outcomes for Benign Disease with Limited Pancreatic Head Resection. Journal of Gastrointestinal Surgery. 2005;9(3): 400 - 409. doi: 10.1016/j.gassur.2004.08.015.
Strobel O, Büchler MW, Werner J. Duodenum-preserving pancreatic head resection: technique according to Beger, technique according to Frey and Berne modifications, Chirurg 80:22–27, 2009. doi: 10.1007/s00104-008-1577-8.
Witzigmann, H, Max, D, Uhlmann, D. Quality of Life in Chronic Pancreatitis: A Prospective Trial Comparing Classical Whipple Procedure and Duodenum-Preserving Pancreatic Head Resection. Journal of Gastrointestinal Surgery. 2002;6(2): 173 - 180. doi: 10.1016/s1091-255x (01)00023-3.
McClaine RJ, Lowy AM, Matthews JB, Schmulewitz N, Sussman JJ, Ingraham AM et al. A comparison of pancreaticoduodenectomy and duodenum-preserving head resection for the treatment of chronic pancreatitis. HPB. 2009; 11: 677 – 683. doi: 10.1111/j.1477-2574.2009.00118.x.
Zheng Z, Xiang G, Tan C, Zhang H, Liu B, Gong J et al. Pancreaticoduodenectomy Versus Duodenum-Preserving Pancreatic Head Resection for the Treatment of Chronic Pancreatitis. Pancreas. 2012;41(1): 147 - 152. doi: 10.1097/MPA.0b013e318221c91b.
Lu WP, Shi Q, Zhang WZ, Cai SW, Jiang K, Dong JH. A meta-analysis of the long-term effects of chronic pancreatitis surgical treatments: duodenum-preserving pancreatic head resection versus pancreatoduodenectomy. Chin Med J. 2013; 126:147–53. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23286494/
Benzing, C, Hau, H.M, Atanasov, G, Krenzien, F, Eisenhauer, T. Surgical therapy of chronic pancreatitis: clinical results and health-related quality of life. Z Gastroenterol. 2018;56(11): 1354-1364. doi: 10.1055/a-0713-0873.
Bachmann, K, Tomkoetter, L, Kutup, A, Erbes, J, Vashist, Y. Is the Whipple Procedure Harmful for Long-term Outcome in Treatment of Chronic Pancreatitis? 15-Years Follow-up Comparing the Outcome after Pylorus-Preserving Pancreatoduodenectomy and Frey Procedure in Chronic Pancreatitis. Ann Surg. 2013;258(5): 815 – 821. doi: 10.1097/SLA.0b013e3182a655a8.
Bachmann, K, Tomkoetter, L, Erbes, J, Hofmann, B, Reeh, M. Beger and Frey Procedures for Treatment of Chronic Pancreatitis: Comparison of Outcomes at 16-Year Follow-Up. Journal of the American College of Surgeons. 2014;219(2): 208-216. doi: 10.1016/j.jamcollsurg.2014.03.040.
Büchler MW, Friess H, Müller MW, Wheatley AM, Beger HG. Randomized Trial of Duodenum-Preserving Pancreatic Head Resection Versus Pylorus- Preserving Whipple in Chronic Pancreatitis. The American Journal of Surgery. 1995; 65 - 70. doi: 10.1016/s0002-9610(99)80111-1.
Croome, K.P, Tee, M, Nagorney, D.M, Truty, M.J, Reid-lombardo, K.M. Pancreatoduodenectomy for Chronic Pancreatitis—Results of a Pain Relief and Quality of Life Survey 15 Years Following Operation. Journal of Gastrointestinal Surgery. 2015;19(12): 2146-2153. doi: 10.1007/s11605-015-2928-7.
Dhar, V.K, Levinsky, N.C, Xia, B.T, Abbott, D.E, Wilson, G.C. The natural history of chronic pancreatitis after operative intervention: The need for revisional operation. Surgery. 2016;160(4): 977-986. doi: 10.1016/j.surg.2016.05.030.
Hildebrand et al. Different surgical strategies for chronic pancreatitis significantly improve long-term outcome: A comparative single center study. Eur J Med Res. 2010; 15: 351 – 356. doi: 10.1186/2047-783x-15-8-351.
Jawad, Z.A.R, Tsim, N, Pai, M, Bansi, D, Westaby, D. Short and long-term post-operative outcomes of duodenum preserving pancreatic head resection for chronic pancreatitis affecting the head of pancreas: a systematic review and meta-analysis. HPB. 2016;18(2): 121-128. doi: 10.1016/j.hpb.2015.10.003.
Keck, T, Adam, U, Makowiec, F, Riediger, H, Wellner, U. Short- and long-term results of duodenum preservation versus resection for the management of chronic pancreatitis: A prospective, randomized study. Surgery. 2012;152(3): S95-S102. doi: 10.1016/j.surg.2012.05.016.
López Gordo S, Busquets J, Peláez N, Secanella L, Martinez-Carnicero L, Ramos E, Fabregat J. Long-term Results of Resection of the Head of the Pancreas Due to Chronic Pancreatitis: Pancreaticoduodenectomy or Duodenum-preserving Cephalic Pancreatectomy? CIR ESP. 2020; 98(5): 267 – 273. doi: 10.1016/j.ciresp.2019.10.009.
Müller, M.W, Friess, H, Hinz, D.J, Dahmen, U, Büchler, R. Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg. 2008;95(3): 350-356. doi: 10.1002/bjs.5960.
Müller, M.W, Friess, H, Leitzbach, S, Michalski, C.W, Berberat, P. Perioperative and follow-up results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis. The American Journal of Surgery. 2008;196(3): 364-372. doi: 10.1016/j.amjsurg.2007.08.065.
Pastewka, A.S, Hampel, M, Górska, M.M, Durlik, M, Derejska, M. Surgical options for chronic pancreatitis- resections or pancreatic tissue sparing procedures? Pancreatology. 2018;18(4): S166.
Strate, T, Bachmann, K, Busch, P, Mann, O, Schneider, C. Resection vs Drainage in Treatment of Chronic Pancreatitis: Long-term Results of a Randomized Trial. Gastroenterology. 2008;134(5): 1406-1411. doi: 10.1053/j.gastro.2008.02.056.
Zhao, Y, Zhang, J, Lan, Z, Jiang, Q, Zhang, S. Duodenum-Preserving Resection of the Pancreatic Head versus Pancreaticoduodenectomy for Treatment of Chronic Pancreatitis with Enlargement of the Pancreatic Head: Systematic Review and Meta-Analysis. BioMed Research International. 2017; (1): 1-15. doi: 10.1155/2017/3565438.
Fischer, T.D, Gutman, D.S, Warner, E.A, Trevino, J.G, Hughes, S.J. Local pancreatic head resection: the search for optimal indications through quality-of-life assessments. The American Journal of Surgery. 2015;210(3): 417-423. doi: 10.1016/j.amjsurg.2014.12.049.
Sukharamwala, P, Patel, K, Teta, A, Parikh, S, Ross, S. Long-term Outcomes Favor Duodenum-preserving Pancreatic Head Resection over Pylorus-preserving Pancreaticoduodenectomy for Chronic Pancreatitis: A Meta-analysis and Systematic Review. The American Surgeon. 2015;81(-): 909 - 914. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26350671/.
Witzigmann, H, Max, D, Uhlmann, D. Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis. Surgery. 2003;134(1): 53 - 62. doi: 10.1067/msy.2003.17
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Derechos de autor 2022 Sergio Silva-Santisteban Gálvez , José Caballero-Alvarado
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
