Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

Published on Sep 7, 2020in Langenbeck's Archives of Surgery3.445
· DOI :10.1007/S00423-020-01972-2
Artur Rebelo3
Estimated H-index: 3
(MLU: Martin Luther University of Halle-Wittenberg),
Ibrahim Büdeyri1
Estimated H-index: 1
(MLU: Martin Luther University of Halle-Wittenberg)
+ 5 AuthorsJörg Kleeff97
Estimated H-index: 97
(MLU: Martin Luther University of Halle-Wittenberg)
OBJECTIVE Advances in multimodality treatment paralleled increasing numbers of complex pancreatic procedures with major vascular resections. The aim of this meta-analysis was to evaluate the current outcomes of arterial resection (AR) in pancreatic surgery. METHODS A systematic literature search was carried out from January 2011 until January 2020. MOOSE guidelines were followed. Predefined outcomes were morbidity, pancreatic fistula, postoperative bleeding and delayed gastric emptying, reoperation rate, mortality, hospital stay, R0 resection rate, and lymph node positivity. Duration of surgery, blood loss, and survival were also analyzed. RESULTS Eight hundred and forty-one AR patients were identified in a cohort of 7111 patients. Morbidity and mortality rates in these patients were 66.8% and 5.3%, respectively. Seven studies (579 AR patients) were included in the meta-analysis. Overall morbidity (48% vs 39%, p = 0.1) and mortality (3.2% vs 1.5%, p = 0.27) were not significantly different in the groups with or without AR. R0 was less frequent in the AR group, both in patients without (69% vs 89%, p < 0.001) and with neoadjuvant treatment (50% vs 86%, p < 0.001). Weighted median survival was shorter in the AR group (18.6 vs 32 months, range 14.8-43.1 months, p = 0.037). CONCLUSIONS Arterial resections increase the complexity of pancreatic surgery, as demonstrated by relevant morbidity and mortality rates. Careful patient selection and multidisciplinary planning remain important.
#1Paula Ghaneh (University of Liverpool)H-Index: 62
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Last. John P. Neoptolemos (University of Liverpool)H-Index: 127
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#2Pietro Addeo (UDS: University of Strasbourg)H-Index: 27
Last. Patrick Dufour (UDS: University of Strasbourg)H-Index: 27
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#1Anouk E J Latenstein (UvA: University of Amsterdam)H-Index: 6
Last. Johanna W. Wilmink (UvA: University of Amsterdam)H-Index: 29
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#2Sally Green (Cochrane Collaboration)H-Index: 67
The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
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#2Nozomu Sakai (Chiba University)H-Index: 15
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The exact contribution of preoperative coil embolization in distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for the prevention of ischemic liver complication is not fully elucidated. From January 2004 to July 2015, 31 patients underwent DP-CAR for the pancreatic body–tail cancer. Twenty-three patients received preoperative coil embolization. The characteristics and operative outcomes were analyzed retrospectively. The median survival time and 1- and 3-year overall survival rate...
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#2Savio G. Barreto (Flinders University)H-Index: 22
Two areas that remain the focus of improvement in pancreatic cancer include high post-operative morbidity and inability to uniformly translate surgical success into long-term survival. This narrative review addresses specific aspects of pancreatic cancer surgery, including neoadjuvant therapy, vascular resections, extended pancreatectomy, extent of lymphadenectomy and current status of minimally invasive surgery. R0 resection confers longer disease-free survival and overall survival. Vascular an...
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