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Open Access 01-11-2020 | Pancreatic Surgery | Systematic Reviews and Meta-analyses

Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

Authors: Artur Rebelo, Ibrahim Büdeyri, Max Heckler, Jumber Partsakhashvili, Jörg Ukkat, Ulrich Ronellenfitsch, Christoph W. Michalski, Jörg Kleeff

Published in: Langenbeck's Archives of Surgery | Issue 7/2020

Abstract

Objective

Advances in multimodality treatment paralleled increasing numbers of complex pancreatic procedures with major vascular resections. The aim of this meta-analysis was to evaluate the current outcomes of arterial resection (AR) in pancreatic surgery.

Methods

A systematic literature search was carried out from January 2011 until January 2020. MOOSE guidelines were followed. Predefined outcomes were morbidity, pancreatic fistula, postoperative bleeding and delayed gastric emptying, reoperation rate, mortality, hospital stay, R0 resection rate, and lymph node positivity. Duration of surgery, blood loss, and survival were also analyzed.

Results

Eight hundred and forty-one AR patients were identified in a cohort of 7111 patients. Morbidity and mortality rates in these patients were 66.8% and 5.3%, respectively. Seven studies (579 AR patients) were included in the meta-analysis. Overall morbidity (48% vs 39%, p = 0.1) and mortality (3.2% vs 1.5%, p = 0.27) were not significantly different in the groups with or without AR. R0 was less frequent in the AR group, both in patients without (69% vs 89%, p < 0.001) and with neoadjuvant treatment (50% vs 86%, p < 0.001). Weighted median survival was shorter in the AR group (18.6 vs 32 months, range 14.8–43.1 months, p = 0.037).

Conclusions

Arterial resections increase the complexity of pancreatic surgery, as demonstrated by relevant morbidity and mortality rates. Careful patient selection and multidisciplinary planning remain important.

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Title: Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection
Authors: Artur Rebelo
Ibrahim Büdeyri
Max Heckler
Jumber Partsakhashvili
Jörg Ukkat
Ulrich Ronellenfitsch
Christoph W. Michalski
Jörg Kleeff
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatic Surgery
Pancreatic Surgery
Pancreatic Cancer
Pancreatic Cancer
Published in: Langenbeck's Archives of Surgery / Issue 7/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01972-2

At a glance: The STEP trials

Springer Medicine

Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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