Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany.
BMJ Open. 2022 Sep 6;12(9):e059977. doi: 10.1136/bmjopen-2021-059977.
Pancreatic surgery is regarded as the only curative treatment for pancreatic cancer (PC). As the neoadjuvant therapy is applied widely nowadays, the proportion of patients with PC undergoing surgery also with locally advanced tumour findings has increased accordingly. Especially in these situations, a radical resection of all tumour tissues is challenging. A novel surgical strategy has been introduced recently to achieve this aim, namely the TRIANGLE operation which comprises the radical resection of all nerve and lymphatic tissue between coeliac artery, superior mesenteric artery and mesenteric-portal axis without including extended lymphadenectomy outside this area. Due to currently published studies, Triangle Operation is a safe and feasible procedure. However, this has not been systematically analysed to date. This systematic review and meta-analysis aim to evaluate surgical and postoperative outcomes of Triangle Operation in pancreatic surgery.
Pubmed, Web of Science and Cochrane Central Register of Controlled Trials in the Cochrane Library will be searched from inception until 31 December 2022. This study will include all articles comparing Triangle Operation versus non-Triangle Operation in pancreatic surgery to assess outcomes. The primary endpoints will be R0 resection rate and 1-year overall survival. The secondary endpoints will be delayed gastric emptying, postoperative pancreatic fistula, post pancreatectomy haemorrhages and reoperation incidence, overall complications, mortality and 3-year overall survival. The study selection, study quality assessment, data extraction and critical appraisal will be carried out by two reviewers. Inter-reviewer disagreements will be evaluated by discussion with a third reviewer. Besides, a subgroup analysis will be conducted focused on robotic surgery, laparoscopic surgery and open surgery in detail. Additionally, the Grading of Recommendations, Assessment, Development and Evaluations framework will be performed to evaluate the strength of evidence.
This systematic review and meta-analysis will not require ethical approval. Results will be published in a peer-reviewed scientific journal.
CRD42021234721.
胰腺切除术被认为是治疗胰腺癌（PC）的唯一根治性治疗方法。由于目前广泛应用新辅助治疗，因此接受手术治疗且肿瘤局部进展的 PC 患者比例相应增加。特别是在这些情况下，根治性切除所有肿瘤组织具有挑战性。最近引入了一种新的手术策略来实现这一目标，即 TRIANGLE 手术，它包括在腹腔动脉、肠系膜上动脉和肠系膜门静脉轴之间的所有神经和淋巴组织的根治性切除，而不包括该区域以外的广泛淋巴结清扫。由于目前发表的研究，Triangle 手术是一种安全可行的手术。然而，到目前为止，这还没有系统地分析过。本系统评价和荟萃分析旨在评估胰腺手术中 Triangle 手术的手术和术后结果。
将从开始到 2022 年 12 月 31 日在 Pubmed、Web of Science 和 Cochrane 图书馆 Cochrane 对照试验中心注册库中搜索文献。本研究将包括所有比较胰腺手术中 Triangle 手术与非 Triangle 手术的文章，以评估结果。主要终点是 R0 切除率和 1 年总生存率。次要终点是胃排空延迟、术后胰瘘、胰腺切除术后出血和再次手术发生率、总并发症、死亡率和 3 年总生存率。将由两名评审员进行研究选择、研究质量评估、数据提取和关键评估。如果两位评审员存在分歧，将通过与第三位评审员讨论来评估。此外，还将进行亚组分析，重点关注机器人手术、腹腔镜手术和开放手术。此外，还将使用推荐评估、发展和评估分级（Grading of Recommendations, Assessment, Development and Evaluations，GRADE）框架来评估证据的强度。
本系统评价和荟萃分析不需要伦理批准。结果将发表在同行评议的科学期刊上。
PROSPERO 注册号：CRD42021234721。
