Thirty-two studies (n=2,822 patients; 1,335 PD and 1,487 PPPD) were included in the review: five RCTs (n=421); 12 prospective non-randomised studies; and 15 retrospective studies. Eleven studies were given nine or more stars for quality and were judged to be high quality.
In comparison with PD, PPPD was associated with shorter operating times (WMD -41.3 min, 95% CI -9.6 to -73.0; 13 studies), increased overall survival (HR 0.66, 95% CI 0.51 to 0.86; nine studies; significant heterogeneity p<0.003), lower perioperative mortality (OR 1.7, 95% CI 1.02 to 2.83; 22 studies) and fewer blood transfusions (WMD 0.9 units, 95% CI 0.85 to 0.96; three studies). No differences between the two groups were reported for postoperative complications, which included pancreatic and biliary leaks or fistulae; only relaparotomy was significantly different and this favoured PPPD (OR 1.59, 95% CI 1.03 to 2.46; six studies).
Overall survival for all tumour types was also significantly improved for PPPD in comparison with PD (HR 0.66, 95% CI 0.51 to 0.86; nine studies). There was no significant difference in overall survival between PD and PPPD for peri-ampullary tumours (seven studies). There was evidence of significant statistical heterogeneity for operating times (p<0.001) and overall survival for all tumour types (p<0.003); no other analyses were significant.
Subgroup analyses for high quality studies and studies published after 2000 did not show any significant differences in operative time between PD and PPPD.