Duodenum erhaltende Pankreaskopfresektion versus Pankreatikoduodenektomie bei der Behandlung der chronischen Pankreatitis - eine systematische Übersichtsarbeit mit Meta-Analyse

Background: The optimal choice of technique for the surgical treatment of pancreatic head lesions in chronic pancreatitis (CP) is still under debate. This systematic review and meta-analysis aims to compare the effectiveness and safety of duodenum-preserving pancreatic head resection (DPPHR) versus pancreatoduodenectomy (PD) by means of parameters of mortality and morbidity as well as functional outcomes and quality of life. Methods: Systematic literature search (Medline, Embase, Biosis, The Cochrane Library and Science Citation Index). Quality assessment and data extraction of identified and included randomized controlled trials (RCTs) comparing DPPHR and PD. Meta-analysis of predefined endpoints (pain relief (primary endpoint), blood loss, operation time, hospital stay, occupational rehabilitation, quality of life etc.) using a random effects-model (Review Manager Software package 4.2.1). Results: 1284 citations were checked for eligibility and 5 RCTs were finally included. Critical appraisal revealed heterogeneous methodological quality of included trials. While postoperative pain relief as well as overall mortality and morbidity showed no significant results, intraoperative blood replacement and hospital stay were significantly reduced in the DPPHR group. Postoperative weight gain, occupational rehabilitation and quality of life were also significantly improved in the DPPHR group. Discussion: This systematic review and meta-analysis suggests that PD has no advantage in terms of effectiveness or safety when compared to DPPHR. Given significant superiority of DPPHR regarding several perioperative outcome parameters as well as improved occupational rehabilitation and quality of life, surgical treatment of chronic pancreatitis has to be re-evaluated in pragmatic multiinstitutional randomized trials to support evidence-based surgical decisions.