c/o University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
J Gastrointest Surg. 2023 Nov;27(11):2611-2627. doi: 10.1007/s11605-023-05789-4. Epub 2023 Sep 5.
Pancreatic benign, cystic, and neuroendocrine neoplasms are increasingly detected and recommended for surgical treatment. In multiorgan resection pancreatoduodenectomy or parenchyma-sparing, local extirpation is a challenge for decision-making regarding surgery-related early and late postoperative morbidity.
PubMed, Embase, and Cochrane Libraries were searched for studies reporting early surgery-related complications following pancreatoduodenectomy (PD) and duodenum-preserving total (DPPHRt) or partial (DPPHRp) pancreatic head resection for benign tumors. Thirty-four cohort studies comprising data from 1099 patients were analyzed. In total, 654 patients underwent DPPHR and 445 patients PD for benign tumors. This review and meta-analysis does not need ethical approval.
Comparing DPPHRt and PD, the need for blood transfusion (OR 0.20, 95% CI 0.10-0.41, p<0.01), re-intervention for serious surgery-related complications (OR 0.48, 95% CI 0.31-0.73, p<0.001), and re-operation for severe complications (OR 0.50, 95% CI 0.26-0.95, p=0.04) were significantly less frequent following DPPHRt. Pancreatic fistula B+C (19.0 to 15.3%, p=0.99) and biliary fistula (6.3 to 4.3%; p=0.33) were in the same range following PD and DPPHRt. In-hospital mortality after DPPHRt was one of 350 patients (0.28%) and after PD eight of 445 patients (1.79%) (OR 0.32, 95% CI 0.10-1.09, p=0.07). Following DPPHRp, there was no mortality among the 192 patients.
DPPHR for benign pancreatic tumors is associated with significantly fewer surgery-related, serious, and severe postoperative complications and lower in-hospital mortality compared to PD. Tailored use of DPPHRt or DPPHRp contributes to a reduction of surgery-related complications. DPPHR has the potential to replace PD for benign tumors and premalignant cystic and neuroendocrine neoplasms of the pancreatic head.
胰腺良性、囊性和神经内分泌肿瘤的检出率不断提高，推荐手术治疗。在多器官切除胰十二指肠切除术或保留实质的局部切除术中，对于与手术相关的早期和晚期术后发病率的决策，胰腺头部分切除术（DPPHRp）或保留十二指肠的全胰腺头切除术（DPPHRt）是一个挑战。
在 PubMed、Embase 和 Cochrane 图书馆中检索了报道良性肿瘤行胰十二指肠切除术（PD）和保留十二指肠的全胰腺头切除术（DPPHRt）或部分胰腺头切除术（DPPHRp）后早期与手术相关并发症的研究。对 34 项队列研究的 1099 例患者的数据进行了分析。共有 654 例患者行 DPPHRt，445 例患者行 PD 治疗良性肿瘤。本综述和荟萃分析不需要伦理批准。
与 PD 相比，DPPHRt 组需要输血（OR 0.20，95%CI 0.10-0.41，p<0.01）、严重手术相关并发症再干预（OR 0.48，95%CI 0.31-0.73，p<0.001）和严重并发症再次手术（OR 0.50，95%CI 0.26-0.95，p=0.04）的频率显著降低。PD 和 DPPHRt 后胰瘘 B+C（19.0 至 15.3%，p=0.99）和胆瘘（6.3 至 4.3%；p=0.33）的发生率相同。DPPHRt 后 350 例患者中有 1 例（0.28%）和 PD 后 445 例患者中有 8 例（1.79%）院内死亡（OR 0.32，95%CI 0.10-1.09，p=0.07）。DPPHRp 后 192 例患者无死亡。
与 PD 相比，DPPHR 治疗胰腺良性肿瘤与手术相关的严重和严重术后并发症发生率显著降低，院内死亡率也较低。DPPHRt 或 DPPHRp 的个体化应用有助于降低手术相关并发症。DPPHR 有可能取代 PD 用于治疗胰腺良性肿瘤和胰腺头部的癌前囊性和神经内分泌肿瘤。
