Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis
Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis
复制标题
DOI：
10.1016/s1499-3872(16)60134-0
复制
发表时间：
2017-04-01
影响因子：
3.3
通讯作者：
Beuran, Mircea
中科院分区：
文献类型：
--
作者：
Negoi, Ionut;Hostiuc, Sorin;Beuran, Mircea
背景：肠系膜上动脉(SMA)第一入路是最近提出的一种新的改良标准的胰腺十二指肠切除术。越来越多的证据表明，在胰腺十二指肠切除术中早期横断SMA的硬膜外切开可以获得更好的围手术期效果，并为长期的肿瘤学益处奠定基础。本研究的目的是比较SMA第一入路胰腺十二指肠切除术(SMA-PD)和标准胰腺十二指肠切除术(S-PD)的手术效果和远期肿瘤学结果。资料来源：应用计算机检索PubMed/MEDLINE、EMBASE、Web of Science和Cochrane Library，直至2015年7月。结果：共有1项随机对照试验(RCT)和13项非随机对照研究(NRCS)符合纳入标准，其中SMA-PD患者640例，S PD患者514例。SMA-PD术中出血少、输血量少、相关静脉切除率高。SMA-PD组胰瘘和胃排空延迟的发生率明显低于对照组。两种方法在总体并发症、主要并发症发生率和住院死亡率方面没有差异。在R0切除率和1年、2年或3年存活率方面没有差异。SMA-PD与较低的局部、肝脏和肝外转移率相关。结论：SMA-PD与较好的围手术期结局有关，如失血、输血要求、胰瘘和胃排空延迟。尽管SMA-PD的1、2、3年总体生存率不高，但局部复发率和转移性复发率较低。
BACKGROUND: The superior mesenteric artery (SMA) first approach was proposed recently as a new modification of the standard pancreaticoduodenectomy. Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenectomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pancreaticoduodenectomy (SMA-PD) with standard pancreaticoduodenectomy (S-PD).DATA SOURCES: Electronic search of the PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Library was performed until July 2015. We considered randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) comparing SMA-PD with S-PD to be eligible if they included patients with periampullary cancers.RESULTS: A total of one RCT and thirteen NRCSs met the inclusion criteria, involving 640 patients with SMA-PD and 514 patients with S-PD. The SMA-PD was associated with less intraoperative bleeding, less blood transfusions and higher rate of associated venous resections. The pancreatic fistula and delayed gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complication rates and in-hospital mortality. There was no difference regarding R0 resection rate, and one-, two- or three-year over all survival. The SMA-PD was associated with a lower local, hepatic and extrahepatic metastatic rate.CONCLUSIONS: The SMA-PD is associated with better perioperative outcomes, such as blood loss, transfusion requirements, pancreatic fistula, and delayed gastric emptying. Although the one-, two- or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic recurrence rate.