Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
Department of Transportation Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
Sci Rep. 2019 Feb 4;9(1):1159. doi: 10.1038/s41598-018-37617-0.
The safety of minimally invasive distal pancreatectomy (MIDP) and open distal pancreatectomy (ODP) regarding oncological outcomes of pancreatic ductal adenocarcinoma (PDAC) remains inconclusive. Therefore, the aim of this study was to examine the oncological safety of MIDP and ODP for PDAC. Major databases including PubMed, Embase, Science Citation Index Expanded, and the Cochrane Library were searched for studies comparing outcomes in patients undergoing MIDP and ODP for PDAC from January 1994 to August 2018. In total, 11 retrospective comparative studies with 4829 patients (MIDP: 1076, ODP: 3753) were included. The primary outcome was long-term survival, including 3-year overall survival (OS) and 5-year OS. The 3-year OS (hazard ratio (HR): 1.03, 95% confidence interval (CI): 0.89, 1.21; P = 0.66) and 5-year OS (HR: 0.91, 95% CI: 0.65, 1.28; P = 0.59) showed no significant differences between the two groups. Furthermore, the positive surgical margin rate (weighted mean difference (WMD): 0.71, 95% CI: 0.56, 0.89, P = 0.003) was lower in the MIDP group. However, patients in the MIDP group had less intraoperative blood loss (WMD: -250.03, 95% CI: -359.68, -140.39; P < 0.00001), a shorter hospital stay (WMD: -2.76, 95% CI: -3.73, -1.78; P < 0.00001) and lower morbidity (OR: 0.57, 95% CI: 0.46, 0.71; P < 0.00001) and mortality (OR: 0.50, 95% CI: 0.31, 0.81, P = 0.005) than patients in the ODP group. The limited evidence suggested that MIDP might be safer with regard to oncological outcomes in PDAC patients. Therefore, future high-quality studies are needed to examine the oncological safety of MIDP.
微创远端胰腺切除术（MIDP）和开放远端胰腺切除术（ODP）在胰腺导管腺癌（PDAC）的肿瘤学结果方面的安全性尚不确定。因此，本研究旨在检查 MIDP 和 ODP 治疗 PDAC 的肿瘤学安全性。主要数据库包括 PubMed、Embase、科学引文索引扩展版和 Cochrane 图书馆，检索了 1994 年 1 月至 2018 年 8 月期间比较 MIDP 和 ODP 治疗 PDAC 患者结局的研究。共纳入 11 项回顾性比较研究，共 4829 例患者（MIDP：1076 例，ODP：3753 例）。主要结局是长期生存，包括 3 年总生存率（OS）和 5 年 OS。两组间 3 年 OS（风险比（HR）：1.03，95%置信区间（CI）：0.89，1.21；P=0.66）和 5 年 OS（HR：0.91，95%CI：0.65，1.28；P=0.59）无显著差异。此外，MIDP 组的阳性切缘率（加权均数差（WMD）：0.71，95%CI：0.56，0.89，P=0.003）较低。然而，MIDP 组术中出血量（WMD：-250.03，95%CI：-359.68，-140.39；P<0.00001）、住院时间（WMD：-2.76，95%CI：-3.73，-1.78；P<0.00001）和并发症发生率（OR：0.57，95%CI：0.46，0.71；P<0.00001）及死亡率（OR：0.50，95%CI：0.31，0.81，P=0.005）均低于 ODP 组。证据有限，提示 MIDP 治疗 PDAC 患者在肿瘤学结果方面可能更安全。因此，需要进一步开展高质量研究来检查 MIDP 的肿瘤学安全性。
