Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
Ann Surg. 2011 Dec;254(6):882-93. doi: 10.1097/SLA.0b013e31823ac299.
The majority of pancreatic cancers are diagnosed at an advanced stage. As surgical resection remains the only hope for cure, more aggressive surgical approaches have been advocated to increase resection rates. Institutions have begun to release data on their experience with pancreatectomy and simultaneous arterial resection (AR), which has traditionally been considered a general contraindication to resection. The aim of the present meta-analysis was to evaluate the perioperative and long-term outcomes of patients with AR during pancreatectomy for pancreatic cancer.
The Medline, Embase, and Cochrane Library and J-East databases were systematically searched to identify studies reporting outcome of patients who underwent pancreatectomy with AR for pancreatic cancer. Studies that reported perioperative and/or long-term results after pancreatectomy with AR were eligible for inclusion. Meta-analyses included comparative studies providing data on patients with and without AR and were performed using a random effects model.
The literature search identified 26 studies including 366 and 2243 patients who underwent pancreatectomy with and without AR. All studies were retrospective cohort studies and the methodological quality was moderate to low. Meta-analyses revealed AR to be associated with a significantly increased risk for perioperative mortality [Odds ratio (OR) = 5.04; 95% confidence interval (CI), 2.69-9.45; P < 0.0001; I² = 24%], poor survival at 1 year (OR = 0.49; 95% CI, 0.31-0.78; P = 0.002; I² = 35%) and 3 years (OR = 0.39; 95% CI, 0.17-0.86; P = 0.02; I² = 49%) compared with patients without AR. The increased perioperative mortality (OR = 8.87; 95% CI, 3.40-23.13; P < 0.0001; I² = 5%) and lower survival rate at 1 year (OR = 0.50; 95% CI, 0.31-0.82; P = 0.006; I² = 40%) was confirmed in the comparison to patients undergoing venous resection. Despite substantial perioperative mortality, pancreatectomy with AR was associated with more favorable survival compared with patients who did not undergo resection for locally advanced disease.
AR in patients undergoing pancreatectomy for pancreatic cancer is associated with a poor short and long-term outcome. Pancreatectomy with AR may, however, be justified in highly selected patients owing to the potential survival benefit compared with patients without resection. These patients should be treated within the bounds of clinical trials to assess outcomes after AR in the era of modern pancreatic surgery and multimodal therapy.
大多数胰腺癌在晚期被诊断出来。由于手术切除仍然是治愈的唯一希望，因此提倡更积极的手术方法以提高切除率。各机构已开始发布其胰腺切除术和同时动脉切除（AR）经验的数据，AR 传统上被认为是切除的一般禁忌症。本荟萃分析的目的是评估 AR 期间胰腺切除术治疗胰腺癌患者的围手术期和长期结果。
系统检索 Medline、Embase 和 Cochrane 图书馆以及 J-East 数据库，以确定报告接受 AR 胰腺切除术治疗胰腺癌患者围手术期和/或长期结果的研究。符合纳入标准的研究是报告 AR 胰腺切除术的围手术期和/或长期结果的研究。荟萃分析包括提供有和没有 AR 的患者数据的比较研究，并使用随机效应模型进行分析。
文献检索确定了 26 项研究，其中包括 366 名和 2243 名接受 AR 胰腺切除术和无 AR 胰腺切除术的患者。所有研究均为回顾性队列研究，方法学质量为中等至低等。荟萃分析显示，AR 与围手术期死亡率显著增加相关[比值比（OR）=5.04；95%置信区间（CI），2.69-9.45；P<0.0001；I²=24%]，1 年（OR=0.49；95%CI，0.31-0.78；P=0.002；I²=35%）和 3 年（OR=0.39；95%CI，0.17-0.86；P=0.02；I²=49%）的生存不良与无 AR 的患者相比。与接受静脉切除的患者相比，围手术期死亡率增加（OR=8.87；95%CI，3.40-23.13；P<0.0001；I²=5%）和 1 年生存率降低（OR=0.50；95%CI，0.31-0.82；P=0.006；I²=40%）也得到了证实。尽管围手术期死亡率很高，但 AR 胰腺切除术与局部晚期疾病患者不切除相比，与更有利的生存相关。然而，由于与未切除患者相比，AR 胰腺切除术具有潜在的生存获益，因此对于某些选择性患者可能是合理的。这些患者应在临床试验范围内进行治疗，以评估现代胰腺外科和多模式治疗时代 AR 后的结果。
