Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection
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SYSTEMATIC REVIEWS AND META-ANALYSES
Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection Artur Rebelo 1 & Ibrahim Büdeyri 1 & Max Heckler 2 & Jumber Partsakhashvili 1 & Jörg Ukkat 1 & Ulrich Ronellenfitsch 1 & Christoph W. Michalski 1 & Jörg Kleeff 1 Received: 16 July 2020 / Accepted: 19 August 2020 # The Author(s) 2020
Abstract 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. Keywords Pancreatic surgery . Arterial resection . Vascular . Pancreatic cancer
Introduction Christoph W. Michalski and Jörg Kleeff contributed equally to this work. Mini-abstract The aim of this meta-analysis was to evaluate current outcomes of arterial resections in pancreatic cancer surgery. The safety of such procedures has increased, but mortality and morbidity remain at considerable levels. Better quality data are needed to more exactly define the value of such resections in the frame of multimodality treatment of pancreatic cancer. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01972-2) contains supplementary material, which is available to authorized users. * Jörg Kleeff [email protected] 1
Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
2
Department for Cancer Immunology and Virology, Dana Farber Cancer Institute, Boston, MA, USA
Surgery for pancreatic cancer has become increasingly safe in the last decades. Complex venous resections are no longer a criterion of
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