Farrarons Sara Sentí, van Bodegraven Eduard A, Sauvanet Alain, Hilal Mohammed Abu, Besselink Marc G, Dokmak Safi
Department of HPB Surgery and Liver Transplantation, Hospital of Beaujon, Paris, France.
Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands.
Surgery. 2022 Nov;172(5):1490-1501. doi: 10.1016/j.surg.2022.06.024. Epub 2022 Aug 18.
This systematic review and meta-analysis aimed to give an overview on the postoperative outcome after a minimally invasive (ie, laparoscopic and robot-assisted) central pancreatectomy and open central pancreatectomy with a specific emphasis on the postoperative pancreatic fistula. For benign and low-grade malignant lesions in the pancreatic neck and body, central pancreatectomy may be an alternative to distal pancreatectomy. Exocrine and endocrine insufficiency occur less often after central pancreatectomy, but the rate of postoperative pancreatic fistula is higher.
An electronic search was performed for studies on elective minimally invasive central pancreatectomy and open central pancreatectomy, which reported on major morbidity and postoperative pancreatic fistula in PubMed, Cochrane Register, Embase, and Google Scholar until June 1, 2021. A review protocol was developed a priori and registered in PROSPERO as CRD42021259738. A meta-regression was performed by using a random effects model.
Overall, 41 studies were included involving 1,004 patients, consisting of 158 laparoscopic minimally invasive central pancreatectomies, 80 robot-assisted minimally invasive central pancreatectomies, and 766 open central pancreatectomies. The overall rate of postoperative pancreatic fistula was 14%, major morbidity 14%, and 30-day mortality 1%. The rates of postoperative pancreatic fistula (17% vs 24%, P = .194), major morbidity (17% vs 14%, P = .672), and new-onset diabetes (3% vs 6%, P = .353) did not differ significantly between minimally invasive central pancreatectomy and open central pancreatectomy, respectively. Minimally invasive central pancreatectomy was associated with significantly fewer blood transfusions, less exocrine pancreatic insufficiency, and fewer readmissions compared with open central pancreatectomy. A meta-regression was performed with a random effects model between minimally invasive central pancreatectomy and open central pancreatectomy and showed no significant difference for postoperative pancreatic fistula (random effects model 0.16 [0.10; 0.24] with P = .789), major morbidity (random effects model 0.20 [0.15; 0.25] with P = .410), and new-onset diabetes mellitus (random effects model 0.04 [0.02; 0.07] with P = .651).
In selected patients and in experienced hands, minimally invasive central pancreatectomy is a safe alternative to open central pancreatectomy for benign and low-grade malignant lesions of the neck and body. Ideally, further research should confirm this with the main focus on postoperative pancreatic fistula and endocrine and exocrine insufficiency.
本系统评价和荟萃分析旨在概述微创（即腹腔镜和机器人辅助）胰体尾切除术及开放胰体尾切除术后的结局，特别关注术后胰瘘情况。对于胰颈和胰体的良性及低级别恶性病变，胰体尾切除术可能是胰体尾切除术的替代方案。胰体尾切除术后外分泌和内分泌功能不全的发生率较低，但术后胰瘘发生率较高。
在PubMed、Cochrane图书馆、Embase和谷歌学术中检索关于择期微创胰体尾切除术和开放胰体尾切除术的研究，这些研究报告了截至2021年6月1日的主要并发症和术后胰瘘情况。预先制定了一项综述方案，并在PROSPERO中注册为CRD42021259738。采用随机效应模型进行荟萃回归分析。
总体而言，纳入了41项研究，共1004例患者，其中包括158例腹腔镜微创胰体尾切除术、80例机器人辅助微创胰体尾切除术和766例开放胰体尾切除术。术后胰瘘总体发生率为14%，主要并发症发生率为14%，30天死亡率为1%。微创胰体尾切除术和开放胰体尾切除术的术后胰瘘发生率（17%对24%，P = 0.194）、主要并发症发生率（17%对14%，P = 0.672）和新发糖尿病发生率（3%对6%，P = 0.353）差异均无统计学意义。与开放胰体尾切除术相比，微创胰体尾切除术的输血次数明显减少，外分泌性胰腺功能不全更少，再入院次数也更少。对微创胰体尾切除术和开放胰体尾切除术采用随机效应模型进行荟萃回归分析，结果显示术后胰瘘（随机效应模型0.16 [0.10; 0.24]，P = 0.789）、主要并发症（随机效应模型0.20 [0.15; 0.25]，P = 0.410）和新发糖尿病（随机效应模型0.04 [0.02; 0.07]，P = 0.651）方面均无显著差异。
对于有经验的术者，在选择合适的患者时，微创胰体尾切除术是治疗胰颈和胰体良性及低级别恶性病变的安全替代开放胰体尾切除术的方法。理想情况下，应开展进一步研究，主要关注术后胰瘘以及内分泌和外分泌功能不全，以证实这一结论。
