gms | German Medical Science

Background: Pancreatic cancer remains under the five leading causes of cancer deaths in industrialized nations. For adenocarcinomas in the head of the gland as well as for premalignant lesions, partial pancreaticoduodenectomy represents the standard treatment for resectable tumours. Bowel continuity after partial pancreaticoduodenectomy can either be reestablished via an antecolic or a retrocolic route. The debate about the more favourable way of bowel reconstruction is still controversial. The objective of this systematic review and meta-analysis is to compare the outcome of antecolic versus retrocolic reconstruction of bowel continuity after partial pancreaticoduodenectomy.

Materials and methods: A systematic literature search was conducted on the 1st of December 2014 to identify all randomised controlled trials in the databases MEDLINE (1946 to December 2014), EMBASE (1974 to December 2014) and the Cochrane Library (until December 2014). Literature screening and data extraction from the included trial was performed by two independent review authors. Data were pooled using a random-effects model for the meta-analysis. Odds ratios were used to compare binary outcomes and mean differences for the comparison of continuous outcomes.

Results: Of a total of 197 hits, six randomised controlled trials with a total of 576 participants were included in this systematic review. Delayed gastric emptiyng (OR 0.62, 95% CI 0.28 to 1.37; P value 0.24), mortality (RD -0.01, 95% CI -0.03 to 0.02; P value 0.72), postoperative pancreatic fistula (OR 0.98, 95% CI 0.65 to 1.47; P value 0.92), postoperative hemorrhage(OR 0.79, 95% CI 0.38 to 1.65; P value 0.53), intraabdominal abscess (OR 0.93, 95% CI 0.52 to 1.67; P value 0.82), reoperation rate (OR 0.59, 95% CI 0.27 to 1.31; P value 0.20) and length of hospital stay (MD -0.67, 95%CI -2.85 to 1.51; P value 0.55) did not differ significantly. Only one trial reported quality of life, also without a significant difference between the two groups at any time point.

Conclusion: The pooled results do not suggest any significant differences in morbidity, mortality, length of hospital stay or quality of life between the antecolic and rectrolic reconstruction routes. Due to heterogeneity in definitions of the endpoints between trials and vast differences in postoperative management, future research should be based on clear defined endpoints and standardised perioperative management to potentially elucidate differences between these two procedures.