Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
Surg Endosc. 2024 Jul;38(7):3531-3546. doi: 10.1007/s00464-024-10900-0. Epub 2024 May 30.
Central pancreatectomy is a surgical procedure for benign and low-grade malignant tumors which located in the neck and proximal body of the pancreas that facilitates the preservation of pancreatic endocrine and exocrine functions but has a high morbidity rate, especially postoperative pancreatic fistula (POPF). The aim of this systematic review and meta-analysis was to evaluate the safety and effectiveness between minimally invasive central pancreatectomy (MICP) and open central pancreatectomy (OCP) basing on perioperative outcomes.
An extensive literature search to compare MICP and OCP was conducted from October 2003 to October 2023 on PubMed, Medline, Embase, Web of Science, and the Cochrane Library. Fixed-effect models or random effects were selected based on heterogeneity, and pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated.
A total of 10 studies with a total of 510 patients were included. There was no significant difference in POPF between MICP and OCP (OR = 0.95; 95% CI [0.64, 1.43]; P = 0.82), whereas intraoperative blood loss (MD = - 125.13; 95% CI [- 194.77, -55.49]; P < 0.001) and length of hospital stay (MD = - 2.86; 95% CI [- 5.00, - 0.72]; P = 0.009) were in favor of MICP compared to OCP, and there was a strong trend toward a lower intraoperative transfusion rate in MICP than in OCP (MD = 0.34; 95% CI [0.11, 1.00]; P = 0.05). There was no significant difference in other outcomes between the two groups.
MICP was as safe and effective as OCP and had less intraoperative blood loss and a shorter length of hospital stay. However, further studies are needed to confirm the results.
胰体中部切除术是一种用于治疗位于胰颈和胰体近端的良性和低级别恶性肿瘤的手术方法，它有利于保留胰腺内分泌和外分泌功能，但并发症发生率较高，尤其是术后胰瘘（POPF）。本系统评价和荟萃分析的目的是基于围手术期结果评估微创胰体中部切除术（MICP）和开放胰体中部切除术（OCP）的安全性和有效性。
从 2003 年 10 月至 2023 年 10 月，我们在 PubMed、Medline、Embase、Web of Science 和 Cochrane 图书馆上进行了广泛的文献检索，以比较 MICP 和 OCP。根据异质性选择固定效应模型或随机效应模型，并计算合并的优势比（OR）或均数差值（MD）及其 95%置信区间（CI）。
共纳入 10 项研究，共计 510 例患者。MICP 和 OCP 之间的 POPF 发生率无显著差异（OR=0.95；95%CI[0.64, 1.43]；P=0.82），但 MICP 术中出血量（MD=-125.13；95%CI[-194.77, -55.49]；P<0.001）和住院时间（MD=-2.86；95%CI[-5.00, -0.72]；P=0.009）均较 OCP 短，MICP 术中输血率也有降低趋势（MD=0.34；95%CI[0.11, 1.00]；P=0.05）。两组其他结局无显著差异。
MICP 与 OCP 一样安全有效，术中出血量更少，住院时间更短。然而，需要进一步的研究来证实这些结果。
