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HPB : the Official Journal of the... Aug 2021Risk factors for the development of clinically relevant POPF (CR-POPF) following distal pancreatectomy (DP) need clarification particularly following the 2016... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition.
BACKGROUND
Risk factors for the development of clinically relevant POPF (CR-POPF) following distal pancreatectomy (DP) need clarification particularly following the 2016 International Study Group of Pancreatic Fistula (ISGPF) definition.
METHODS
A systemic search of MEDLINE, Pubmed, Scopus, and EMBASE were conducted using the PRISMA framework. Studies were evaluated for risk factors for the development CR-POPF after DP using the 2016 ISGPF definition. Further subgroup analysis was undertaken on studies ≥10 patients in exposed and non-exposed subgroups.
RESULTS
Forty-three studies with 8864 patients were included in the meta-analysis. The weighted rate of CR-POPF was 20.4% (95%-CI: 17.7-23.4%). Smoking (OR 1.29, 95%-CI: 1.08-1.53, p = 0.02) and open DP (OR 1.43, 95%-CI: 1.02-2.01, p = 0.04) were found to be significant risk factors of CR-POPF. Diabetes (OR 0.81, 95%-CI: 0.68-0.95, p = 0.02) was a significant protective factor against CR-POPF. Substantial heterogeneity was observed in the comparisons of pancreatic texture and body mass index. Seventeen risk factors achieved significance in a univariate or multivariate comparison as reported by individual studies in the narrative synthesis, however, they remain difficult to interpret as statistically significant comparisons were not uniform.
CONCLUSION
This meta-analysis found smoking and open DP to be risk factors and diabetes to be protective factor of CR-POPF in the era of 2016 ISGPF definition.
Topics: Humans; Pancreas; Pancreatectomy; Pancreatic Fistula; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 33820687
DOI: 10.1016/j.hpb.2021.02.015 -
Pancreas Jul 2014Insulinoma with an incidence of 0.4% is a rare pancreatic tumor. Preserving surgery is the treatment of choice. Exact localization is necessary to plan the appropriate... (Review)
Review
OBJECTIVE
Insulinoma with an incidence of 0.4% is a rare pancreatic tumor. Preserving surgery is the treatment of choice. Exact localization is necessary to plan the appropriate approach. This article gives an overview on localization and surgical strategies for treatment of insulinoma.
METHODS
In this systematic review, 114 articles with 6222 cases of insulinoma were reviewed with emphasis on localization techniques and surgical treatment.
RESULTS
Insulinoma happens mostly in the fifth decade of life, with a higher incidence in men. They occur mostly sporadic (94%), benign (87%), and single (90%). Insulinomas are mostly smaller than 20 mm (84%). The tumors are distributed almost equally in the pancreas.
CONCLUSIONS
Computed tomography is routinely used as first choice preoperatively. Intraoperative inspection, palpation, and sonography were applied with high success rate. Intraoperative sonography is considered as the most reliable technique. Enucleation is the most administered type of surgery (56%). Different types of resection include distal pancreatectomy (32%), Whipple procedure (3%), and subtotal pancreatectomy (<3%). Despite the development of laparoscopy, open approach is the favorite method (90%). The most common surgical complication is fistula. The mortality rate of open approach was higher (4 vs 0%). Despite high cure rate, recurrence of insulinoma occurs in 7% after surgery.
Topics: Age Factors; Female; Humans; Insulinoma; Male; Middle Aged; Outcome Assessment, Health Care; Pancreatectomy; Pancreatic Neoplasms; Sex Factors
PubMed: 24921202
DOI: 10.1097/MPA.0000000000000110 -
HPB : the Official Journal of the... Jul 2022Morbidity and mortality from post-pancreatectomy haemorrhage (PPH) remains high. The International Study Group of Pancreatic Surgery (ISGPS) published guidelines to...
BACKGROUND
Morbidity and mortality from post-pancreatectomy haemorrhage (PPH) remains high. The International Study Group of Pancreatic Surgery (ISGPS) published guidelines to standardise definitions of PPH severity, management and reporting. This study aimed to i) identify the number of studies reporting PPH using ISGPS guidelines (Grade A, B or C) and ii) describe treatment modality success by grade.
METHODS
A systematic literature review was performed, identifying studies reporting PPH by ISGPS Grade and their subsequent management.
RESULTS
Of 62 studies reporting on PPH management, 17 (27.4%) stratified by ISGPS guidelines and included 608 incidences of PPH: 48 Grade A, 274 Grade B (62 early, 166 late, 46 unspecified) and 286 Grade C. 96% of Grade A PPH were treated conservatively. Of 62 early Grade B, 54.8% were managed conservatively and 37.1% surgically. Late Grade B were managed non-operatively in 25.3% (42/166), with successful endoscopy in 90.9% (10/11) and angiography in 90.3% (28/31). In Grade C, endoscopic treatment was successful in 64.4% (29/45) and angiography in 90.8% (108/119). Surgical intervention was required in 43.5% early Grade B, 7.8% late Grade B and 33.2% Grade C.
CONCLUSION
PPH grading is underreported and despite guidelines, inconsistencies remain when using definitions and reporting of outcomes.
Topics: Angiography; Humans; Pancreatectomy; Postoperative Hemorrhage; Time Factors; Treatment Outcome
PubMed: 35101359
DOI: 10.1016/j.hpb.2021.12.002 -
World Journal of Gastroenterology Dec 2014To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed. (Review)
Review
AIM
To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.
METHODS
A systematic review of the literature was performed using the Medline, Embase, PubMed, and Cochrane databases to identify all studies published up to 2013 that compared laparoscopic and open liver [laparoscopic hepatic resection (LLR) vs open liver resection (OLR)] and pancreatic [laparoscopic pancreatic resection (LPR) vs open pancreatic resection] resection. The last search was conducted on October 30, 2013.
RESULTS
Four studies reported that LLR was associated with lower ward stay cost than OLR (2972 USD vs 5291 USD). The costs related to equipment (3345 USD vs 2207 USD) and theatre (14538 vs 11406) were reported higher for LLR. The total cost was lower in patients managed by LLR (19269 USD) compared to OLR (23419 USD). Four studies reported that LPR was associated with lower ward stay cost than OLR (6755 vs 9826 USD). The costs related to equipment (2496 USD vs 1630 USD) and theatre (5563 vs 4444) were reported higher for LPR. The total cost was lower in the LPR (8825 USD) compared to OLR (13380 USD).
CONCLUSION
This systematic review support the economic advantage of laparoscopic over open approach to liver and pancreatic resection.
Topics: Cost Savings; Cost-Benefit Analysis; Hepatectomy; Hospital Costs; Humans; Laparoscopy; Pancreatectomy; Treatment Outcome
PubMed: 25516675
DOI: 10.3748/wjg.v20.i46.17595 -
Annals of Surgery Open : Perspectives... Mar 2022To depict and analyze learning curves for open, laparoscopic, and robotic pancreatoduodenectomy (PD) and distal pancreatectomy (DP). (Review)
Review
OBJECTIVE
To depict and analyze learning curves for open, laparoscopic, and robotic pancreatoduodenectomy (PD) and distal pancreatectomy (DP).
BACKGROUND
Formal training is recommended for safe introduction of pancreatic surgery but definitions of learning curves vary and have not been standardized.
METHODS
A systematic search on PubMed, Web of Science, and CENTRAL databases identified studies on learning curves in pancreatic surgery. Primary outcome was the number needed to reach the learning curve as defined by the included studies. Secondary outcomes included endpoints defining learning curves, methods of analysis (statistical/arbitrary), and classification of learning phases.
RESULTS
Out of 1115 articles, 66 studies with 14,206 patients were included. Thirty-five studies (53%) based the learning curve analysis on statistical calculations. Most often used parameters to define learning curves were operative time (n = 51), blood loss (n = 17), and complications (n = 10). The number of procedures to surpass a first phase of learning curve was 30 (20-50) for open PD, 39 (11-60) for laparoscopic PD, 25 (8-100) for robotic PD ( = 0.521), 16 (3-17) for laparoscopic DP, and 15 (5-37) for robotic DP ( = 0.914). In a three-phase model, intraoperative parameters improved earlier (first to second phase: operating time -15%, blood loss -29%) whereas postoperative parameters improved later (second to third phase: complications -46%, postoperative pancreatic fistula -48%). Studies with higher sample sizes showed higher numbers of procedures needed to overcome the learning curve (rho = 0.64, < 0.001).
CONCLUSIONS
This study summarizes learning curves for open-, laparoscopic-, and robotic pancreatic surgery with different definitions, analysis methods, and confounding factors. A standardized reporting of learning curves and definition of phases (competency, proficiency, mastery) is desirable and proposed.
PubMed: 37600094
DOI: 10.1097/AS9.0000000000000111 -
Journal of Gastrointestinal Surgery :... Nov 2011This systematic review and meta-analysis aims to characterize the surgically important benefits and complications associated with the use of neoadjuvant... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This systematic review and meta-analysis aims to characterize the surgically important benefits and complications associated with the use of neoadjuvant chemoradiotherapy for the treatment of both resectable and initially unresectable pancreatic cancer. Studies were identified through a systematic literature search and analyzed by two independent reviewers. Survival, peri-operative complications, death rate, pancreatic fistula rate, and the incidence of involved surgical margins were analyzed and subject to meta-analysis.
METHODS
Nineteen studies, involving 2,148 patients were identified. Only cohort studies were included.
RESULTS
The meta-analysis found that patients with unresectable pancreatic cancer who underwent neoadjuvant chemoradiotherapy achieved similar survival outcomes to patients with resectable disease, even though only 40% were ultimately resected. Neoadjuvant chemoradiotherapy was not associated with a statistically significant increase in the rate of pancreatic fistula formation or total complications.
CONCLUSION
Patients receiving neoadjuvant chemoradiotherapy were less likely to have a positive resection margin, although there was an increase in the risk of peri-operative death.
Topics: Carcinoma; Chemoradiotherapy, Adjuvant; Humans; Neoadjuvant Therapy; Pancreatectomy; Pancreatic Neoplasms; Survival Analysis
PubMed: 21913045
DOI: 10.1007/s11605-011-1659-7 -
The Surgeon : Journal of the Royal... Apr 2016Spleen-preserving distal pancreatectomy (SPDP) can be performed either by ligating (SPDP-VL) or preserving (SPDP-VP) the splenic vessels. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Spleen-preserving distal pancreatectomy (SPDP) can be performed either by ligating (SPDP-VL) or preserving (SPDP-VP) the splenic vessels.
METHODS
A systematic review was performed, and standard PRISMA guidelines were followed. A literature search was conducted using Medline, PubMed and the Cochrane Central Register of Controlled Trials between January 1988 and May 2014. The article titles and abstracts were examined by two independent reviewers.
RESULTS
Thirteen non-randomized control trials were included in the meta-analysis. The pooled data included 667 patients who underwent SPDP. There were 209 patients in the SPDP-VL group and 458 patients in the SPDP-VP group. The risk of splenic infarction was significantly higher in the SPDP-VL group [20.88 vs. 2.09%; OR 11.89 (95% CI 4.33 to 32.70); p < 0.00001]. The rate of splenectomy as a result of splenic infarction was also statistically associated with SPDP-VL [7.69% vs. 1.36%; OR 3.87 (95% CI 1.05 to 14.26); p = 0.05)]. The surgical operative time was shorter in the SPDP-VL group than in the SPDP-VP group (mean difference 21.2 min), but this result was not statistically significant (95% CI -47.01 to -4.48; p = 0.11). The two procedures were comparable with respect to mean intraoperative blood loss and rate of pancreatic fistula. SPDP-VL did not influence the risk of developing perigastric collateral vessels and submucosal varices.
CONCLUSIONS
SPDP-VL may result in a higher rate of splenic infarction and splenectomy than SPDP-VP. However, the low quality of the included studies does not lead to clear conclusions.
Topics: Blood Loss, Surgical; Humans; Ligation; Pancreatectomy; Pancreatic Diseases; Postoperative Complications; Spleen; Splenic Artery; Veins
PubMed: 26723134
DOI: 10.1016/j.surge.2015.11.002 -
Annals of Surgical Oncology Feb 2016The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation.
METHODS
PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes.
RESULTS
Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105-114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297-330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 % CI 1.2-3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 % CI 1.0-2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 % CI 0.1-0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 % CI 0.02-0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93-98) and 84 % (range 79-90).
CONCLUSIONS
Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.
Topics: Eye Enucleation; Humans; Pancreatectomy; Pancreatic Neoplasms; Postoperative Complications; Prognosis; Surgical Procedures, Operative
PubMed: 26307231
DOI: 10.1245/s10434-015-4826-3 -
Journal of Minimal Access Surgery 2022In the era of minimally invasive procedures and as a way to decrease the incidence of post-operative pancreatic fistula (POPF), the use of staplers for distal... (Review)
Review
BACKGROUND AND AIM
In the era of minimally invasive procedures and as a way to decrease the incidence of post-operative pancreatic fistula (POPF), the use of staplers for distal pancreatectomy (DP) has increased dramatically. Our aim was to investigate whether reinforced staplers decrease the incidence of clinically relevant PF after DP compared with staplers without reinforcement.
METHODS
PubMed, Scopus, Web of Science and Cochrane Library were searched for eligible studies from inception to 1 November 2021, and a systematic review and a meta-analysis were done to detect the outcomes after using reinforced staplers versus standard stapler for DP.
RESULTS
Seven studies with a total of 681 patients were included. The overall incidence of POPF and the incidence of Grade A POPF after DP are similar for the two groups (overall POPF, risk ratio [RR] = 0.85, 95% confidence interval [CI] = 0.71-1.01, P = 0.06; I = 38% and Grade A POPF, RR = 1.15, 95% CI = 0.78-1.69, P = 0.47; I = 49%). However, the incidence of clinically significant POPF (Grades B and C) is significantly lower in DP with reinforced staplers than DP with bare staplers (Grades B and C, RR = 0.45, 95% CI = 0.29-0.71, P = 0.0005; I = 17%). Nevertheless, the time of the operation, the blood loss during surgical procedure, the hospital stay after the surgery and the thickness of the pancreas are similar for both techniques.
CONCLUSION
Although staple line reinforcement after DP failed to prevent biochemical PF, it significantly reduced the rate of clinically relevant POPF in comparison to standard stapling.
PubMed: 35708377
DOI: 10.4103/jmas.jmas_47_22 -
Journal of Surgical Oncology Feb 2017The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the short-term postoperative clinical outcomes in patients undergoing DP with splenectomy (DPS) or spleen preservation (SPDP).
METHODS
Online database search was performed (2000 to present); key bibliographies were reviewed. Studies comparing patients undergoing DP with either DPS or SPDP, and assessing postoperative complications were included.
RESULTS
Meta-analysis of included data showed SPDP patients had significantly less operative blood loss, shorter duration of hospitalization, lower incidence of fluid collection and abscess, lower incidence of postoperative splenic and portal vein thrombosis, and lower incidence of new onset postoperative diabetes. For the whole group, there was no difference in incidence of postoperative pancreatic fistula (POPF) (RR = 0.95; 95%CI 0.65-1.40, P = 0.80), however, subgroup analysis of studies using ISGPF criteria showed that DPS patients had increased rates of Grade B/C POPF (RR = 1.35; 95%CI 1.08-1.70, P = 0.01).
CONCLUSIONS
SPDP for benign and low grade malignant tumors is associated with shorter hospital stay and decreased morbidity compared to DPS. J. Surg. Oncol. 2017;115:137-143. © 2017 Wiley Periodicals, Inc.
Topics: Humans; Minimally Invasive Surgical Procedures; Organ Preservation; Pancreatectomy; Pancreatic Neoplasms; Postoperative Complications; Spleen; Treatment Outcome
PubMed: 28133818
DOI: 10.1002/jso.24507