Wei Kongyuan, Zheng Qingyong, Cheng Luying, Li Wei, Nießen Anna, Uzunoglu Faik G, Nickel Felix, Tian Jinhui, Wang Zheng, Hackert Thilo
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
Pancreatic Disease Center of Xi'an Jiaotong University, Xi'an, China.
Int J Surg. 2024 Dec 1;110(12):8250-8255. doi: 10.1097/JS9.0000000000002143.
Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) have been diagnosed increasingly often but still represent rare pancreatic neoplasms. Surgery is a potentially curative approach for patients with NF-PNETs. In recent years, minimally invasive surgery (MIS) has been applied more frequently for surgical resection of NF-PNETs. The evidence for using MIS for NF-PNETs is still being determined and controversial.
PubMed, Cochrane Library, and the Web of Science database were searched systematically from its inception to July 2023. All studies comparing MIS versus open surgery (OPS) of NF-PNETs were included. The primary outcomes were the incidence of overall postoperative complications and pancreas-specific complications [postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE)]. The secondary measures were duration of operation, intraoperative blood loss, and length of postoperative hospital stay. Pooled results are presented as odds ratios (OR) or mean difference (MD) with a 95% CI.
Five observational studies with a total of 1178 patients were included in the final analysis. The meta-analysis indicated that MIS attained less intraoperative blood loss (MD=-58.59, 95% CI [-92.76 to -24.41], P<0.01) and shorter length of hospital stay (MD=-3.07, 95% CI [-5.28 to -0.87], P<0.01) in contrast to open surgery for NF-PNETs. There were no significant differences concerning operative time (MD=52.04, 95% CI [-8.74 to 112.81], P=0.67), overall postoperative complications (OR=0.78, 95% CI [0.59-1.03], P=0.08), POPF (OR=0.99, 95% CI [0.66-1.47], P=0.94), and DGE (OR=0.58, 95% CI [0.58-1.42], P=0.67).
This study demonstrates that minimally invasive surgery for NF-PNETs is safe and associated with a considerably shorter postoperative hospital stay. Further studies are needed to verify the evidence.
无功能性胰腺神经内分泌肿瘤（NF-PNETs）的诊断越来越常见，但仍是罕见的胰腺肿瘤。手术是NF-PNETs患者潜在的治愈方法。近年来，微创手术（MIS）在NF-PNETs手术切除中的应用越来越频繁。使用MIS治疗NF-PNETs的证据仍在确定中，且存在争议。
对PubMed、Cochrane图书馆和Web of Science数据库从建库至2023年7月进行系统检索。纳入所有比较NF-PNETs的MIS与开放手术（OPS）的研究。主要结局是术后总体并发症及胰腺特异性并发症[术后胰瘘（POPF）和胃排空延迟（DGE）]的发生率。次要指标为手术时间、术中失血量和术后住院时间。汇总结果以比值比（OR）或均差（MD）及95%置信区间表示。
最终分析纳入了5项观察性研究，共1178例患者。荟萃分析表明，与NF-PNETs的开放手术相比，MIS术中失血量更少（MD=-58.59，95%CI[-92.76至-24.41]，P<0.01），住院时间更短（MD=-3.07，95%CI[-5.28至-0.87]，P<0.01）。手术时间（MD=52.04，95%CI[-8.74至112.81]，P=0.67）、术后总体并发症（OR=0.78，95%CI[0.59 - 1.03]，P=0.08）、POPF（OR=0.99，95%CI[0.66 - 1.47]，P=0.94）和DGE（OR=0.58，95%CI[0.58 - 1.42]，P=0.67）方面无显著差异。
本研究表明，NF-PNETs的微创手术是安全的，且术后住院时间显著缩短。需要进一步研究来验证该证据。
