The Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, China.
Cui-ying Biomedical Research Center, The Second Hospital of Lanzhou University, Lanzhou, China.
Int J Surg. 2020 Jan;73:14-24. doi: 10.1016/j.ijsu.2019.11.007. Epub 2019 Nov 18.
Superior mesenteric artery (SMA) first approach was a new improvement for pancreaticoduodenectomy (PD), but there is no evidence whether this approach is advantageous to PD. This meta-analysis aimed to determine the effects of the superior mesenteric artery (SMA) first approach on outcomes of pancreaticoduodenectomy (PD).
Literature searches were conducted on PubMed, The Cochrane Library, EMBASE, Web of Science, Clinical Trials Registry and China Biology Medicine disc. We completed a meta-analysis of the SMA first approach in PD, assessing overall survival, R0 resection, blood loss, postoperative complications, operation time and postoperative stay. The odds ratios and weighted mean differences with 95% confidence intervals (CIs) were pooled.
Eighteen studies comprising 1483 participants were included. Patients who received SMA-PD had significantly lower overall complication rate (OR 0.62, 95% CI 0.47 to 0.81, P = 0.001) and less blood loss (WMD -264.84, 95% CI -336.1 to -193.58, P < 0.001). The obviously increased R0 resection rate (OR 2.92, 95% CI 1.72 to 4.96, P < 0.001) and 3-year OS (OR 2.15, 95% CI 1.34 to 3.43, P = 0.001) were found in the SMA-PD group.
The SMA-PD group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients; furthermore, the patients acquired superior clinical efficacy via the posterior approach in SMA-PD.
肠系膜上动脉（SMA）优先入路是胰十二指肠切除术（PD）的一项新改进，但尚无证据表明这种方法对 PD 有利。本荟萃分析旨在确定肠系膜上动脉（SMA）优先入路对胰十二指肠切除术（PD）结果的影响。
在 PubMed、The Cochrane Library、EMBASE、Web of Science、临床试验注册处和中国生物医学文献数据库上进行文献检索。我们对 SMA 优先入路在 PD 中的应用进行了荟萃分析，评估总生存率、R0 切除率、出血量、术后并发症、手术时间和术后住院时间。汇总了优势比和加权均数差值及其 95%置信区间（CI）。
纳入了 18 项研究，共 1483 名参与者。接受 SMA-PD 的患者总并发症发生率显著降低（OR 0.62，95%CI 0.47 至 0.81，P=0.001），出血量减少（WMD -264.84，95%CI -336.1 至 -193.58，P<0.001）。SMA-PD 组的 R0 切除率（OR 2.92，95%CI 1.72 至 4.96，P<0.001）和 3 年 OS 率（OR 2.15，95%CI 1.34 至 3.43，P=0.001）明显升高。
SMA-PD 组的临床结局更好，特别是在胰腺癌患者的长期生存方面；此外，SMA-PD 组的患者通过 SMA 后入路获得了更好的临床疗效。
