Efficacy of duodenum-preserving pancreatic head resection versus pancreaticoduodenectomy in the treatment of chronic pancreatitis in adults: Systematic Review and Meta-Analysis.
DOI:
https://doi.org/10.35434/rcmhnaaa.2022.15Supl.%201.1607Keywords:
Chronic pancreatitis, pancreatic resection, duodenal preservation, efficacyAbstract
Background: Studies comparing duodenum-preserving pancreatic head resection versus pancreaticoduodenectomy in the treatment of chronic pancreatitis demonstrate notable differences, however, the current evidence is inadequate to clearly establish the superiority of these approaches. Objective: To determine duodenum preserving pancreatic head resection is more effective than pancreaticoduodenectomy in treating chronic pancreatitis in adults. Material and Methods: A systematic review was conducted identifying and extracting data from seven randomized clinical trials and seven observational studies comparing the efficacy of duodenum-preserving pancreatic resection versus pancreaticoduodenectomy. Results: Bleeding had a mean difference (MD) of -0.18, 95% CI of -0.25 – -0.12, and p < 0.00001. Operative time had an MD of -1.32, 95% CI of -2.20 – -0.44 and p = 0.003. Hospital stay had an MD of -3.94, 95% CI of -6.16 – -1.71 and p = 0.0005. Endocrine insufficiency had a RR of 0.78, 95% CI of 0.65 – 0.95 and p = 0.01. Pain Score showed an MD of -7.39, 95% CI of -13.05 – -1.74 and p = 0.01. Global quality of life, showed MD of 8.97, 95% CI of 4.05 - 13.90 and p = 0.0004. Conclusions: DPPHR is more effective than PD by reducing intraoperative bleeding, operative time, hospital stay, the risk of endocrine failure, and by providing better pain relief and quality of life.
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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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Copyright (c) 2022 Sergio Silva-Santisteban Gálvez , José Caballero-Alvarado
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