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

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.

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.

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).

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.