Pancreaticoduodenectomy (Whipple's procedure) for pancreatic cancer

Pylorus-preserving pancreaticoduodenectomy (pp Whipple) may be equal to pancreaticoduodenectomy (classic Whipple) in terms of mortality, morbidity and survival for surgical treatment of periampullary and pancreatic carcinoma.

A Cochrane review included 8 studies with a total of 512 subjects. Pancreaticoduodenectomy (classic Whipple) was compared to pylorus-preserving pancreaticoduodenectomy (PPW). The comparison of overall in-hospital mortality (OR 0.64; 95% CI 0.26 to 1.54), overall survival (hazard ratio 0.84; 95% CI 0.61 to 1.16) and morbidity showed no significant difference except of delayed gastric emptying, which significantly favoured CW (OR 3.03, 95% CI 1.05 to 8.70). Furthermore, operating time (MD -45.22 minutes, 95% CI -74.67 to -15.78), intraoperative blood loss (MD -0.32 L, 95% CI -0.62 to -0.03), and red blood cell transfusion (MD -0.47 units, 95% CI -0.86 to -0.07) were significantly reduced in the PPW group.

Comment. The quality of evidence is downgraded by study quality and imprecise results (wide confidence intervals).

Ədəbiyyat

1. Hüttner FJ, Fitzmaurice C, Schwarzer G et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2016;2():CD006053. .