Liu Lu, Liu Tian-Xiang, Huang Wan-Xia, Yang Zhong, Wang Shang, Da Ming-Xu, Dong Yang
College of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China; Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, China.
Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, China.
Asian J Surg. 2022 Jan;45(1):51-61. doi: 10.1016/j.asjsur.2021.06.002. Epub 2021 Jun 26.
Distal pancreatectomy with En-bloc celiac axis resection (DP-CAR) is a challenging procedure that has yielded certain clinical efficacy in the treatment of locally advanced pancreatic body/tail cancer, especially in patients with invasion of abdominal vessels. However, the clinical efficacy and safety of DP-CAR remain controversial. The study aimed to systematically review efficacy and safety of DP-CAR in the treatment of locally advanced pancreatic body/tail cancer. We systematically searched PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception to 1 October 2020. Two studiers independently accomplished the study selection, data extraction, and quality assessment. Initially, of 1032 studies were searched, among which 11 high quality studies including 1072 patients were finally identified. The pooled results showed that DP-CAR versus Distal pancreatectomy (DP), the rate of R0 resection (RR = 0.76; 95%CI: 0.66 to 0.88; p = 0.0002) and 3-year survival (RR = 0.65; 95%CI: 0.43 to 0.98; p = 0.04) was lower, postoperative mortality (RR = 2.48; 95%CI: 1.02 to 6.03; p = 0.04) was higher, the operation time (MD = 104.67; 95%CI: 84.70 to 124.64; p < 0.001) and hospital stay (MD = 3.94, 95% CI 1.35 to 6.53; p = 0.003) were longer. There was no statistical difference between the DP-CAR and DP group in 1-year, 2-year survival rate (RR = 0.84; 95%CI: 0.57 to 1.23; p = 0.37) (RR = 0.70; 95%CI: 0.45 to 1.10; p = 0.12). In conclusion, compared with DP, DP-CAR has worse efficacy and prognosis survival and is more dangerous, but it can obtain better survival benefit and quality of life than palliative treatment. We suggest that DP-CAR can be carefully attempted for effective margin-negative resection. However, surgeons and patients need to know its potential perioperative risk.
联合腹腔干整块切除的远端胰腺切除术（DP-CAR）是一项具有挑战性的手术，在治疗局部晚期胰体/尾癌方面已产生了一定的临床疗效，尤其是对于侵犯腹部血管的患者。然而，DP-CAR的临床疗效和安全性仍存在争议。本研究旨在系统评价DP-CAR治疗局部晚期胰体/尾癌的疗效和安全性。我们系统检索了PubMed、EMBASE、Cochrane图书馆和Web of Science数据库，检索时间从建库至2020年10月1日。两名研究者独立完成研究筛选、数据提取和质量评估。最初，共检索到1032项研究，最终确定了11项高质量研究，共纳入1072例患者。汇总结果显示，与单纯远端胰腺切除术（DP）相比，DP-CAR的R0切除率（RR = 0.76；95%CI：0.66至0.88；p = 0.0002）和3年生存率（RR = 0.65；95%CI：0.43至0.98；p = 0.04）较低，术后死亡率（RR = 2.48；95%CI：1.02至6.03；p = 0.04）较高，手术时间（MD = 104.67；95%CI：84.70至124.64；p < 0.001）和住院时间（MD = 3.94，95%CI 1.35至6.53；p = 0.003）更长。DP-CAR组与DP组在1年、2年生存率方面无统计学差异（RR = 0.84；95%CI：0.57至1.23；p = 0.37）（RR = 0.70；95%CI：0.45至1.10；p = 0.12）。总之，与DP相比，DP-CAR的疗效和预后生存较差且更危险，但与姑息治疗相比，它能获得更好的生存获益和生活质量。我们建议，对于有效的切缘阴性切除可谨慎尝试DP-CAR。然而，外科医生和患者需要了解其潜在的围手术期风险。
