Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis

// Shuisheng Zhang 1, * , Zhongmin Lan 1, * , Jianwei Zhang 1 , Yingtai Chen 1 , Quan Xu 1 , Qinglong Jiang 1 , Yajie Zhao 1 , Chengfeng Wang 1 , Xiaoning Bi 2 and Xiaozhun Huang 3 1 Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China 2 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China 3 Department of Abdominal Surgery, Cancer Hospital of Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen Cancer Hospital, Shenzhen, 518116, China * These authors have contributed equally to this work Correspondence to: Chengfeng Wang, email: lifeofwater@126.com Keywords: duct-to-mucosa, invagination, pancreaticojejunostomy (PJ), pancreaticoduodenectomy (PD), postoperative pancreatic fistula (POPF) Received: October 27, 2016     Accepted: April 11, 2017     Published: April 28, 2017 ABSTRACT Objective: We aimed to compare the two most commonly used pancreatico-jejunostomy reconstruction techniques—duct-to-mucosa and invagination. Methods: Databases, including MEDLINE, EMBASE, Cochrane Library, and several clinical trial registration centers were searched. Randomized controlled trials that compared duct-to-mucosa and invagination pancreaticojejunostomy techniques after pancreaticoduodenectomy were included and analyzed. Results: In total, seven RCTs were included, involving 850 patients. The difference in postoperative pancreatic fistula rate between the duct-to-mucosa and invagination pancreaticojejunostomy was not significant (RR = 1.03, 95% CI = 0.76-1.39, P = 0.86). There was no significant difference in clinically relevant postoperative pancreatic fistula between the two groups (RR = 0.78, 95% CI = 0.15-3.96, P = 0.77). The overall morbidity, overall mortality, delayed gastric emptying, intra-abdominal collection, reoperation rate, and length of hospital stay between the two groups were not significantly different. Sensitivity analysis showed that the meta-analysis was stable. Further, no significant publication bias was seen. Conclusions: Duct-to-mucosa and invagination pancreaticojejunostomy techniques after pancreaticoduodenectomy were comparable in terms of postoperative pancreatic fistula incidence and other parameters.