Pylorus preservation after total pancreatectomy: a systematic review and meta-analysis

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-09-01 DOI:10.1016/j.pan.2025.08.013

Mohamed Ali Chaouch , Heithem Jeddou , Edouard Wasiekewski , Marie Livin , Raffaele Vincenzo De Rosa , Antoine Castel , Aude Merdrignac , Fabien Robin , Laurent Sulpice

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引用次数: 0

Abstract

Background

Total pancreatectomy (TP) is a major surgical procedure often associated with significant morbidity. Pylorus preservation (PP) during TP aims to minimize postoperative complications, particularly delayed gastric emptying (DGE), while maintaining gastrointestinal function. However, their impact remains controversial. This study systematically reviewed and analyzed the outcomes of TP with and without pylorus preservation.

Methods

A systematic review and meta-analysis were conducted following the PRISMA and AMSTAR 2 guidelines. Randomized controlled trials and controlled clinical trials comparing TP with PP (PP group) and TP without PP (non-PP group) were included. The primary outcome analyzed was delayed gastric emptying (DGE), while the secondary outcomes included morbidity, anastomotic ulcer, cholangitis, blood loss, operative time, and hospital stay.

Results

Four eligible studies (167 patients, 93 PP, and 74 non-PP) were included. No significant differences were found between the PP and non-PP groups in terms of DGE (OR = 1.35, 95 % CI [0.41, 4.44], p = 0.62), overall morbidity (OR = 1.21, 95 % CI [0.38, 3.85], p = 0.75), anastomotic ulcer (OR = 0.99, 95 % CI [0.15, 6.61], p = 0.99), cholangitis (OR = 1.47, 95 % CI [0.07, 31.53], p = 0.8), or blood loss (MD = 18.89, 95 % CI [-164.98, 202.76], p = 0.84). The PP group had a significantly shorter operative time than the non-PP group (MD = −0.62, 95 % CI [-0.90, −0.33], p < 0.001).

Conclusions

PP during TP can reduce operative time but does not significantly impact postoperative outcomes, such as DGE, morbidity, or hospital stay. More prospective studies are needed to confirm these findings and to explore the potential benefits of PP in minimally invasive surgical approaches.

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全胰切除术后幽门保留：一项系统回顾和荟萃分析。

背景：全胰切除术（TP）是一种主要的外科手术，通常伴有显著的发病率。在TP术中保留幽门（PP）旨在减少术后并发症，特别是胃排空延迟（DGE），同时维持胃肠功能。然而，它们的影响仍然存在争议。本研究系统地回顾和分析了保留幽门和不保留幽门的TP的结果。方法：根据PRISMA和AMSTAR 2指南进行系统回顾和荟萃分析。纳入TP加PP （PP组）和TP不加PP（非PP组）的随机对照试验和临床对照试验。分析的主要结局是胃排空延迟（DGE），次要结局包括发病率、吻合口溃疡、胆管炎、失血、手术时间和住院时间。结果：纳入了4项符合条件的研究（167例患者，93例PP， 74例非PP）。PP组与非PP组在DGE （OR = 1.35, 95% CI [0.41, 4.44], p = 0.62）、总发病率（OR = 1.21, 95% CI [0.38, 3.85], p = 0.75）、吻合口溃疡（OR = 0.99, 95% CI [0.15, 6.61], p = 0.99）、胆管炎（OR = 1.47, 95% CI [0.07, 31.53], p = 0.8）、失血量（MD = 18.89, 95% CI [-164.98, 202.76], p = 0.84）方面均无显著差异。PP组手术时间明显短于非PP组（MD = -0.62, 95% CI [-0.90, -0.33], p < 0.001）。结论：TP期间的PP可以缩短手术时间，但对术后预后，如DGE、发病率或住院时间没有显著影响。需要更多的前瞻性研究来证实这些发现，并探讨PP在微创手术入路中的潜在益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.