The clinical implication of minimally invasive versus open pancreatoduodenectomy for non-pancreatic periampullary cancer: a systematic review and individual patient data meta-analysis.
The clinical implication of minimally invasive versus open pancreatoduodenectomy for non-pancreatic periampullary cancer: a systematic review and individual patient data meta-analysis.
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DOI：
10.1007/s00423-023-03047-4
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发表时间：
2023-08-15
影响因子：
2.3
通讯作者：
Abu Hilal, Mohammed
中科院分区：
文献类型：
--
作者：
Uijterwijk, Bas A.;Kasai, Meidai;Lemmers, Daniel H. L.;Chinnusamy, Palanivelu;van Hilst, Jony;Ielpo, Benedetto;Wei, Kongyuan;Song, Ki Byung;Kim, Song C.;Klompmaker, Sjors;Jang, Jin-Young;Herremans, Kelly M.;Bencini, Lapo;Coratti, Andrea;Mazzola, Michele;Menon, Krishna, V;Goh, Brian K. P.;Qin, Renyi;Besselink, Marc G.;Abu Hilal, Mohammed
关键词：
大多数微创胰十二指肠切除术（MIPD）的研究将胰腺和壶腹周围癌患者合并，尽管这些肿瘤之间存在很大的异质性。因此，本研究旨在评估MIPD与开放式胰十二指肠切除术（OPD）在非胰腺性壶腹周围癌（NPPC）患者中的作用。由两名独立评审员对Pubmed、Embase和Cochrane数据库进行了系统评价，以确定比较MIPD和OPD治疗NPPC（壶腹、远端胆管和十二指肠腺癌）的研究（2015年1月- 2021年12月）。所有确定的研究都需要患者的个人资料。主要结局是（90天）死亡率和主要发病率（Clavien-Dindo 3a-5）。次要结局是术后胰瘘（POPF）、胃排空延迟（DGE）、胰腺切除术后出血（PPH）、失血、住院时间（LOS）和总生存期（OS）。总的来说，16项研究纳入了1949例患者，其中928例为壶腹癌，526例为远端胆管癌，461例为十二指肠癌。共有902例（46.3%）患者接受了MIPD， 1047例（53.7%）患者接受了OPD。90天死亡率、主要发病率、POPF、DGE、PPH、出血量和住院时间在MIPD和OPD之间没有差异。MIPD组手术时间延长67 min （P = 0.009）。MIPD组胃腹癌（HR 2.27, P = 0.019）和胆管远端癌（HR 1.84, P = 0.025）的DFS降低，胆管远端癌（HR 1.71, P = 0.045）和十二指肠癌（HR 4.59, P < 0.001）的OS降低。这项针对NPPC患者的MIPD与OPD的个体数据荟萃分析表明，就短期发病率和死亡率而言，MIPD并不逊色。长期数据的几个主要限制突出了研究空白，应该在前瞻性维护的国际注册或随机研究中分别对壶腹癌、远端胆管癌和十二指肠癌进行研究。普洛斯彼罗（CRD42021277495）将于2021年10月25日上市。在线版本包含补充材料，可在10.1007/s00423-023-03047-4获得。
Most studies on minimally invasive pancreatoduodenectomy (MIPD) combine patients with pancreatic and periampullary cancers even though there is substantial heterogeneity between these tumors. Therefore, this study aimed to evaluate the role of MIPD compared to open pancreatoduodenectomy (OPD) in patients with non-pancreatic periampullary cancer (NPPC). A systematic review of Pubmed, Embase, and Cochrane databases was performed by two independent reviewers to identify studies comparing MIPD and OPD for NPPC (ampullary, distal cholangio, and duodenal adenocarcinoma) (01/2015–12/2021). Individual patient data were required from all identified studies. Primary outcomes were (90-day) mortality, and major morbidity (Clavien-Dindo 3a-5). Secondary outcomes were postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), blood-loss, length of hospital stay (LOS), and overall survival (OS). Overall, 16 studies with 1949 patients were included, combining 928 patients with ampullary, 526 with distal cholangio, and 461 with duodenal cancer. In total, 902 (46.3%) patients underwent MIPD, and 1047 (53.7%) patients underwent OPD. The rates of 90-day mortality, major morbidity, POPF, DGE, PPH, blood-loss, and length of hospital stay did not differ between MIPD and OPD. Operation time was 67 min longer in the MIPD group (P = 0.009). A decrease in DFS for ampullary (HR 2.27, P = 0.019) and distal cholangio (HR 1.84, P = 0.025) cancer, as well as a decrease in OS for distal cholangio (HR 1.71, P = 0.045) and duodenal cancer (HR 4.59, P < 0.001) was found in the MIPD group. This individual patient data meta-analysis of MIPD versus OPD in patients with NPPC suggests that MIPD is not inferior in terms of short-term morbidity and mortality. Several major limitations in long-term data highlight a research gap that should be studied in prospective maintained international registries or randomized studies for ampullary, distal cholangio, and duodenum cancer separately. PROSPERO (CRD42021277495) on the 25th of October 2021. The online version contains supplementary material available at 10.1007/s00423-023-03047-4.
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发表时间：
2017-10-01
影响因子：
3.1
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