Summary of findings for the main comparison. Duodenum‐preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis (primary outcomes).
| Patient or population: people requiring surgery for chronic pancreatitis Setting: surgical unit Intervention: duodenum‐preserving pancreatic resection Comparison: pancreaticoduodenectomy | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with pancreaticoduodenectomy | Risk with duodenum‐preserving pancreatic resection | |||||
| Short‐term mortality | 10 per 1000 | 29 per 1000 (3 to 269) | RR 2.89 (0.31 to 26.87) | 269 (5 RCTs) | ⊕⊝⊝⊝ Very low1,2 | ‐ |
| Long‐term mortality | 281 per 1000 | 193 per 1000 (97 to 357) | HR 0.65 (0.31 to 1.34) | 229 (4 RCTs) | ⊕⊝⊝⊝ Very low1,3,4 | ‐ |
| Serious adverse events | ‐ | ‐ | ‐ | ‐ | ‐ | None of the included studies reported serious adverse events. Table 2 summarises non‐serious adverse events |
| Quality of life (3 months to 5 years) | The median quality of life ranged between 28.6 and 67 | The median quality of life ranged between 67 and 85.7 | ‐ | 146 (4 RCTs) | ⊕⊝⊝⊝ Very low1,5 | EORTC QLQ‐C30 global health value (higher means better) |
| Quality of life (> 5 years) | The mean quality of life (> 5 years) was 58 | The mean quality of life (> 5 years) in the intervention group was 8.45 more (0.27 fewer to 17.18 more) | ‐ | 101 (2 RCTs) | ⊕⊕⊝⊝ Low1 | EORTC QLQ‐C30 global health value (higher means better) |
| None of the trials reported the following outcomes: quality of life (4 weeks to 3 months), clinically significant pancreatic fistulas, serious adverse events, time to return to normal activity, time to return to work, and pain scores using a visual analogue scale. | ||||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group (mean control group proportion for all outcomes except short‐term mortality where an assumed risk of 1% was used as there was no short‐term mortality in the control group in the trials included in this review) and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HR: hazard ratio; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 The trial(s) was/were of unclear or high risk of bias.
2 Although the event was a rare event, the confidence intervals were wide even when absolute measures were used. The sample size was small.
3 The I2 value was high and there was lack of overlap of confidence intervals.
4 The confidence intervals were wide and the sample size was small.
5 There was inconsistency in the results.