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World Journal of Surgery Aug 2022There is no consensus on the pancreatic transection during distal pancreatectomy (DP) to reduce postoperative pancreatic fistula (POPF). This meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is no consensus on the pancreatic transection during distal pancreatectomy (DP) to reduce postoperative pancreatic fistula (POPF). This meta-analysis aimed to evaluate the effects of a reinforced stapler on the postoperative outcomes of DP.
METHODS
We systematically searched electronic databases and bibliographic reference lists in The PubMed/MEDLINE, Google Scholar, Cochrane Library's Controlled Trials Registry and Database of Systematic Reviews, Embase, and Scopus. Review Manager Software was used for pooled estimates.
RESULTS
Seven eligible studies published between 2007 and 2021 were included with 553 patients (267 patients in the reinforced stapler group and 286 patients in the standard stapler group). The reinforced stapler reduced the POPF grade B and C (OR = 0.33; 95% CI [0.19, 0.57], p < 0.01). There was no difference between the reinforced stapler group and standard stapler group in terms of mortality rate (OR = 0.39; 95% CI [0.04, 3.57], p = 0.40), postoperative haemorrhage (OR = 0.53; 95% CI [0.20, 1.43], p = 0.21), and reoperation rate (OR = 0.91; 95% CI [0.40, 2.06], p = 0.82).
CONCLUSIONS
Reinforced stapling in DP is safe and seems to reduce POPF grade B/C with similar mortality rates, postoperative bleeding, and reoperation rate. The protocol of this systematic review with meta-analysis was registered in PROSPERO (ID: CRD42021286849).
Topics: Humans; Incidence; Pancreas; Pancreatectomy; Pancreatic Fistula; Postoperative Complications; Risk Factors
PubMed: 35525852
DOI: 10.1007/s00268-022-06572-3 -
World Journal of Transplantation Jan 2023Despite the increased use of total pancreatectomy with islet autotransplantation (TPIAT), systematic evidence of its outcomes remains limited.
BACKGROUND
Despite the increased use of total pancreatectomy with islet autotransplantation (TPIAT), systematic evidence of its outcomes remains limited.
AIM
To evaluate the outcomes of TPIAT.
METHODS
We searched PubMed, EMBASE, and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes. Data were extracted and analyzed using comprehensive meta-analysis software. The random-effects model was used for all variables. Heterogeneity was assessed using the I measure and Cochrane Q-statistic. Publication bias was assessed using Egger's test.
RESULTS
Twenty-one studies published between 1980 and 2017 examining 1011 patients were included. Eighteen studies were of adults, while three studied pediatric populations. Narcotic independence was achieved in 53.5% [95% Confidence Interval (CI): 45-62, < 0.05, I = 81%] of adults compared to 51.9% (95%CI: 17-85, < 0.05, I = 84%) of children. Insulin-independence post-procedure was achieved in 31.8% (95%CI: 26-38, < 0.05, I = 64%) of adults with considerable heterogeneity compared to 47.7% (95%CI: 20-77, < 0.05, I = 82%) in children. Glycated hemoglobin (HbA) 12 mo post-surgery was reported in four studies with a pooled value of 6.76% ( = 0.27). Neither stratification by age of the studied population nor meta-regression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies.
CONCLUSION
These results indicate acceptable success for TPIAT. Future studies should evaluate the discussed measures before and after surgery for comparison.
PubMed: 36687559
DOI: 10.5500/wjt.v13.i1.10 -
Frontiers in Surgery 2023Postoperative acute pancreatitis (POAP) is a specific complication after pancreatectomy. The acute inflammatory response of the residual pancreas may affect the healing... (Review)
Review
BACKGROUND
Postoperative acute pancreatitis (POAP) is a specific complication after pancreatectomy. The acute inflammatory response of the residual pancreas may affect the healing of pancreatoenteric anastomoses, leading to postoperative pancreatic fistulas (POPFs), abdominal infections, and even progressive systemic reactions, conditions that negatively affect patients' prognoses and can cause death. However, to the best of our knowledge, no systematic reviews or meta-analytic studies have assessed the incidence and risk factors of POAP after pancreaticoduodenectomy (PD).
METHOD
We searched PubMed, Web of Science, Embase, and Cochrane Library databases for relevant literature describing the outcomes of POAP after PD until November 25, 2022, and we used the Newcastle-Ottawa Scale to assess the quality of the studies. Next, we pooled the incidence of POAP and the odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors using a random-effect meta-analysis. tests were used to assess heterogeneity between the studies.
RESULTS
We analyzed data from 7,164 patients after PD from 23 articles that met the inclusion criteria for this study. The subgroup results of the meta-analysis by different POAP diagnostic criteria showed that the incidences of POAP were 15% (95% CI, 5-38) in the International Study Group for Pancreatic Surgery group, 51% (95% CI, 42-60) in the Connor group, 7% (95% CI, 2-24) in the Atlanta group, and 5% (95% CI, 2-14) in the unclear group. Being a woman [OR (1.37, 95% CI, 1.06-1.77)] or having a soft pancreatic texture [OR (2.56, 95% CI, 1.70-3.86)] were risk factors of POAP after PD.
CONCLUSION
The results showed that POAP was common after PD, and its incidence varied widely according to different definitions. Large-scale reports are still needed, and surgeons should remain aware of this complication.
SYSTEMATIC REVIEW REGISTRATION
identifier: CRD42022375124.
PubMed: 37228763
DOI: 10.3389/fsurg.2023.1150053 -
World Journal of Surgery Nov 2016Postoperative pancreatic fistula (POPF) causes significant morbidity and mortality after distal pancreatectomy. Patch coverage of the pancreatic stump is often used with... (Meta-Analysis)
Meta-Analysis Review
Autologous but not Fibrin Sealant Patches for Stump Coverage Reduce Clinically Relevant Pancreatic Fistula in Distal Pancreatectomy: A Systematic Review and Meta-analysis.
BACKGROUND
Postoperative pancreatic fistula (POPF) causes significant morbidity and mortality after distal pancreatectomy. Patch coverage of the pancreatic stump is often used with the intention to prevent POPF. Despite numerous investigations, the effects of patch coverage remain unclear. The present meta-analysis aims to clarify the effects of patch coverage in distal pancreatectomy on the incidence of POPF.
METHODS
A systematic search of MEDLINE/PubMed and the Cochrane Database according to the PRISMA Statement was performed. Subsequently a meta-analysis on rates and overall incidence of POPF and length of hospital stay was carried out. By applying the inverse variance weighting method, the combined effect size and 95 % confidence interval were calculated. Heterogeneity was assessed using I statistics.
RESULTS
Five randomized controlled trials and six observational clinical studies were included for final analysis. A cumulative incidence of 43 % of POPF grades A-C was identified. Patch coverage in distal pancreatectomy is significantly associated with a decreased rate of POPF grade C (p = 0.006). Patches of autologous vascularized tissue significantly reduce the overall incidence of POPF (p = 0.04) and clinically relevant POPF grade B and C (p = 0.002). Fibrin sealant patches do not influence rates of POPF after distal pancreatectomy. None of the outcomes evaluated showed adverse results for the patch group.
CONCLUSIONS
Patch coverage after distal pancreatectomy can reduce the rate of POPF. Patch coverage with autologous vascularized tissue but not fibrin sealant patches may be used to reduce clinically relevant POPF and postoperative morbidity in distal pancreatectomy.
Topics: Fibrin Tissue Adhesive; Humans; Pancreatectomy; Pancreatic Fistula; Randomized Controlled Trials as Topic; Surgical Flaps; Transplantation, Autologous
PubMed: 27343014
DOI: 10.1007/s00268-016-3612-0 -
Hepatobiliary & Pancreatic Diseases... Oct 2014The use of laparoscopic distal pancreatectomy (LDP) increased in the past twenty years but the real diffusion of this technique is still unknown as well as the type of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The use of laparoscopic distal pancreatectomy (LDP) increased in the past twenty years but the real diffusion of this technique is still unknown as well as the type of centers (high or low volume) in which this procedure is more frequently performed.
DATA SOURCE
A systematic review was performed to evaluate the frequency of LDP in Italy and to compare indications and results in high volume centers (HVCs) and in low volume centers (LVCs).
RESULTS
From 95 potentially relevant citations identified, only 5 studies were included. A total of 125 subjects were analyzed, of whom 95 (76.0%) were from HVCs and 30 (24.0%) from LVCs. The mean number of LDPs performed per year was 6.5. The mean number of patients who underwent LDP per year was 8.8 in HVCs and 3.0 in LVCs (P<0.001). The most frequent lesions operated on in HVCs were cystic tumors (62.1%, P<0.001) while, in LVCs, solid neoplasms (76.7%, P<0.001). In HVCs, malignant neoplasms were treated with LDP less frequently than in LVCs (17.9% vs 50.0%, P<0.001). Splenectomy was performed for non-oncologic reason frequenter in HVCs than in LVCs (70.2% vs 25.0%, P=0.004). The length of stay was shorter in HVCs than in LVCs (7.5 vs 11.3, P<0.001). No differences were found regarding age, gender, ductal adenocarcinoma treated, operative time, conversion, morbidity, postoperative pancreatic fistula, reoperation and margin status.
CONCLUSIONS
LDPs were frequently performed in Italy. The "HVC approach" is characterized by a careful selection of patients undergoing LDP. The "LVC approach" is based on the hypothesis that LDPs are equivalent both in short-term and long-term results to laparotomic approach. These data are not conclusive and they point out the need for a national register of laparoscopic pancreatectomy.
Topics: Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Italy; Laparoscopy; Length of Stay; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Reoperation; Splenectomy
PubMed: 25308355
DOI: 10.1016/s1499-3872(14)60297-6 -
Surgery Feb 2022The incidence of and risk factors for chyle leak, as defined by the 2017 International Study Group on Pancreatic Surgery, remain unknown. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of and risk factors for chyle leak, as defined by the 2017 International Study Group on Pancreatic Surgery, remain unknown.
METHODS
MEDLINE, EMBASE, and Scopus were systematically searched for studies of patients undergoing pancreatectomy that reported chyle leak according to the 2017 International Study Group on Pancreatic Surgery definition. The primary outcomes were the incidence of overall and clinically relevant chyle leak. A random-effects pairwise meta-analysis was used to calculate the incidence of chyle leak.
RESULTS
Thirty-five studies including 7,083 patients were included in the meta-analysis. The weighted incidence of overall chyle leak was 6.8% (95% confidence interval 5.6-8.2), and clinically relevant chyle leak was 5.5% (95% confidence interval 3.8-7.7). Pancreaticoduodenectomy, total pancreatectomy, and distal pancreatectomy were associated with a CL incidence of 7.3%, 4.3%, and 5.8%, respectively. Fourteen individual risk factors for chyle leak were identified from included studies. Younger age, low prognostic nutritional index, para-aortic node manipulation, lymphatic involvement, and post-pancreatectomy pancreatitis were significantly associated with chyle leak, all from individual studies.
CONCLUSION
The incidence of overall chyle leak and clinically relevant chyle leak after pancreatic surgery, as defined by the 2017 International Study Group on Pancreatic Surgery, is 6.8% and 5.5%, respectively. Several risk factors for chyle leak were identified in the present review; however, larger high-quality studies are needed to more accurately define these risks.
Topics: Age Factors; Aged; Anastomosis, Surgical; Anastomotic Leak; Chyle; Humans; Incidence; Middle Aged; Nutrition Assessment; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pancreatitis; Risk Factors
PubMed: 34417025
DOI: 10.1016/j.surg.2021.07.021 -
Frontiers in Oncology 2022The aim of this study was to compare the safety and overall effect of robotic distal pancreatectomy (RDP) to laparoscopic distal pancreatectomy (LDP) after the learning...
AIM
The aim of this study was to compare the safety and overall effect of robotic distal pancreatectomy (RDP) to laparoscopic distal pancreatectomy (LDP) after the learning curve, especially in perioperative outcome and short-term oncological outcome.
METHODS
A literature search was performed by two authors independently using PubMed, Embase, and Web of Science to identify any studies comparing the results of RDP versus LDP published until 5 January 2022. Only the studies where RDP was performed in more than 35 cases were included in this study. We performed a meta-analysis of operative time, blood loss, reoperation, readmission, hospital stay, overall complications, major complications, postoperative pancreatic fistula (POPF), blood transfusion, conversion to open surgery, spleen preservation, tumor size, R0 resection, and lymph node dissection.
RESULTS
Our search identified 15 eligible studies, totaling 4,062 patients (1,413 RDP). It seems that the RDP group had a higher rate of smaller tumor size than the LDP group (MD: -0.15; 95% CI: -0.20 to -0.09; < 0.00001). Furthermore, compared with LPD, RDP was associated with a higher spleen preservation rate (OR: 2.19; 95% CI: 1.36-3.54; = 0.001) and lower rate of conversion to open surgery (OR: 0.43; 95% CI: 0.33-0.55; < 0.00001). Our study revealed that there were no significant differences in operative time, overall complications, major complications, blood loss, blood transfusion, reoperation, readmission, POPF, and lymph node dissection between RDP and LDP.
CONCLUSIONS
RDP is safe and feasible for distal pancreatectomy compared with LDP, and it can reduce the rate of conversion to open surgery and increase the rate of spleen preservation, which needs to be further confirmed by quality comparative studies with large samples.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
PubMed: 36106111
DOI: 10.3389/fonc.2022.954227 -
Pancreas Apr 2019This review aimed to inventory and analyze previous studies regarding quality of life (QoL) and psychological outcomes in relation to pancreatectomy. PubMed and PsycInfo... (Meta-Analysis)
Meta-Analysis
This review aimed to inventory and analyze previous studies regarding quality of life (QoL) and psychological outcomes in relation to pancreatectomy. PubMed and PsycInfo databases were reviewed using the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Thirteen studies were selected, 9 of which focused on the QoL after surgery. Quality of life significantly improved 3 to 6 months after surgery. Regarding the postoperative experience, one study reported high fear of recurrence of cancer, whereas another emphasized various expressions of patient needs. One study explained how strategy and ability to adapt are not related to the type, the cause, nor the physical condition, but are mainly influenced by the age and the subjective experience of the patients. A last study showed that depression did not affect survival rate after surgery. Our systematic review found only few studies regarding the psychological condition after pancreatectomy and highlights the need to describe and characterize the patients' psychological characteristics in this setting.
Topics: Adaptation, Psychological; Anxiety; Chemotherapy, Adjuvant; Depression; Humans; Outcome Assessment, Health Care; Pancreatectomy; Pancreatic Neoplasms; Quality of Life; Surveys and Questionnaires
PubMed: 30973462
DOI: 10.1097/MPA.0000000000001279 -
Surgical Laparoscopy, Endoscopy &... Aug 2015The aim of this study is to analyze the learning curve for laparoscopic distal pancreatectomy (LDP) in our series and review the literature on learning curves for LDP... (Review)
Review
BACKGROUND
The aim of this study is to analyze the learning curve for laparoscopic distal pancreatectomy (LDP) in our series and review the literature on learning curves for LDP and robotic distal pancreatectomy (RDP).
METHODS
Learning curve analysis was performed by split group and cumulative sum (CUSUM) analysis of blood loss, operative time, and length of stay. The systematic review identified studies analyzing changes in outcome with experience.
RESULTS
A total of 25 resections were performed. CUSUM analysis of operative time found learning curves of 10 cases for LDP and splenectomy and 11 for LDP with splenic preservation. CUSUM analysis of blood loss showed approximately 6 cases. In the literature, values of 10 cases of LDP and approximately 7 RDP were found.
CONCLUSIONS
Low numbers of LDP are required to reach proficiency in the hands of expert laparoscopic surgeons. Our results correspond with numbers quoted in the literature.
Topics: Humans; Laparoscopy; Learning Curve; Operative Time; Pancreatectomy; Pancreatic Neoplasms; Robotics; Treatment Outcome
PubMed: 26147049
DOI: 10.1097/SLE.0000000000000185 -
Pancreatology : Official Journal of the... Sep 2022In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-).
METHODS
A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test.
RESULTS
Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar.
CONCLUSION
VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.
Topics: Humans; Mesenteric Veins; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Retrospective Studies
PubMed: 35697587
DOI: 10.1016/j.pan.2022.05.001