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Cancer Management and Research 2019To assess whether total pancreatectomy (TP) is as feasible, safe, and efficacious as pancreaticoduodenectomy (PD). Major databases, including PubMed, EMBASE, Science... (Review)
Review
To assess whether total pancreatectomy (TP) is as feasible, safe, and efficacious as pancreaticoduodenectomy (PD). Major databases, including PubMed, EMBASE, Science Citation Index Expanded, Scopus and the Cochrane Library, were searched for studies comparing TP and PD between January 1943 and June 2018. The meta-analysis only included studies that were conducted after 2000. The primary outcomes were morbidity and mortality. Pooled odds ratios (ORs), weighted mean differences (WMDs) or hazard ratios (HRs) with 95 percent confidence intervals (CIs) were calculated using fixed effects or random effects models. The methodological quality of the included studies was evaluated by the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. In total, 45 studies were included in this systematic review, and 5 non-randomized comparative studies with 786 patients (TP: 270, PD: 516) were included in the meta-analysis. There were no differences in terms of mortality (OR: 1.44, 95% CI: 0.66-3.16; =0.36), hospital stay (WMD: -0.60, 95% CI: -1.78-0.59; =0.32) and rates of reoperation (OR: 1.12; 95% CI: 0.55-2.31; =0.75) between the two groups. In addition, morbidity was not significantly different between the two groups (OR: 1.41, 95% CI: 1.01-1.97; =0.05); however, the results showed that the TP group tended to have more complications than the PD group. Furthermore, the operation time (WMD: 29.56, 95% CI: 8.23-50.89; =0.007) was longer in the TP group. Blood loss (WMD: 339.96, 95% CI: 117.74-562.18; =0.003) and blood transfusion (OR: 4.86, 95% CI: 1.93-12.29; =0.0008) were more common in the TP group than in the PD group. There were no differences in the long-term survival rates between the two groups. This systematic review and meta-analysis suggested that TP may not be as feasible and safe as PD. However, TP and PD may have the same efficacy.
PubMed: 31123419
DOI: 10.2147/CMAR.S195726 -
International Journal of Surgery... Jul 2023The aim of this study was to perform a systematic review and meta-analysis on the safety and effectiveness regarding outcomes of minimally invasive total pancreatectomy... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this study was to perform a systematic review and meta-analysis on the safety and effectiveness regarding outcomes of minimally invasive total pancreatectomy (MITP) versus open total pancreatectomy (OTP).
BACKGROUND
Total pancreatectomy is a complicated operation in abdominal surgery. The flexibility of minimally invasive surgery offers a new surgical approach to this technology. At present, there is little research on MITP, and its advantages over OTP remain uncertain.
METHODS
A systematic literature review and meta-analysis was conducted basing on comparative studies between MITP and OTP from January 1943 to November 2022. Intraoperative outcomes and postoperative outcomes were assessed. Pooled odds ratios (ORs) and mean differences with a 95% CI were calculated using fixed-effect or random-effect models under heterogeneity.
RESULTS
Seven studies with a total of 4275 patients were included. The major morbidity in the MITP group was significant lower (OR 0.50, 95% CI: 0.30-0.84, P=0.008, I²= 0%) than OTP group. At the same time, comparing with OTP, the MITP group had lower estimated blood loss (MD -362.50, 95% CI -641.34 to -83.66, P=0.01, I²=96%) and lower intraoperative transfusion rate (OR 0.36, 95% CI 0.16-0.84, P=0.02, I²=0%). There were no significant differences between the MITP and OTP groups for other outcomes.
CONCLUSIONS
The results suggested that MITP was associated with lower major morbidity, estimated blood loss, and intraoperative transfusion rate comparing with OTP. However, the further evidence with a better design is required.
Topics: Humans; Pancreatectomy; Blood Loss, Surgical; Minimally Invasive Surgical Procedures; Length of Stay; Blood Transfusion; Postoperative Complications
PubMed: 37485920
DOI: 10.1097/JS9.0000000000000392 -
Annals of Surgery Oct 2023Examine the potential benefit of total pancreatectomy (TP) as an alternative to pancreatoduodenectomy (PD) in patients at high risk for postoperative pancreatic fistula... (Meta-Analysis)
Meta-Analysis
Systematic Review and Meta-analysis of the Role of Total Pancreatectomy as an Alternative to Pancreatoduodenectomy in Patients at High Risk for Postoperative Pancreatic Fistula: Is it a Justifiable Indication?
OBJECTIVE
Examine the potential benefit of total pancreatectomy (TP) as an alternative to pancreatoduodenectomy (PD) in patients at high risk for postoperative pancreatic fistula (POPF).
SUMMARY BACKGROUND DATA
TP is mentioned as an alternative to PD in patients at high risk for POPF, but a systematic review is lacking.
METHODS
Systematic review and meta-analyses using Pubmed, Embase (Ovid), and Cochrane Library to identify studies published up to October 2022, comparing elective single-stage TP for any indication versus PD in patients at high risk for POPF. The primary endpoint was short-term mortality. Secondary endpoints were major morbidity (i.e., Clavien-Dindo grade ≥IIIa) on the short-term and quality of life.
RESULTS
After screening 1212 unique records, five studies with 707 patients (334 TP and 373 high-risk PD) met the eligibility criteria, comprising one randomized controlled trial and four observational studies. The 90-day mortality after TP and PD did not differ (6.3% vs. 6.2%; RR=1.04 [95%CI 0.56-1.93]). Major morbidity rate was lower after TP compared to PD (26.7% vs. 38.3%; RR=0.65 [95%CI 0.48-0.89]), but no significance was seen in matched/randomized studies (29.0% vs. 36.9%; RR = 0.73 [95%CI 0.48-1.10]). Two studies investigated quality of life (EORTC QLQ-C30) at a median of 30-52 months, demonstrating comparable global health status after TP and PD (77% [±15] vs. 76% [±20]; P =0.857).
CONCLUSIONS
This systematic review and meta-analysis found no reduction in short-term mortality and major morbidity after TP as compared to PD in patients at high risk for POPF. However, if TP is used as a bail-out procedure, the comparable long-term quality of life is reassuring.
Topics: Humans; Pancreatectomy; Pancreaticoduodenectomy; Pancreatic Fistula; Quality of Life; Pancreas; Postoperative Complications
PubMed: 37161977
DOI: 10.1097/SLA.0000000000005895 -
The British Journal of Surgery Dec 2019Surgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent...
BACKGROUND
Surgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent studies have suggested that outcomes following total pancreatectomy have improved, but a systematic review is lacking.
METHODS
A systematic review was undertaken of studies reporting on outcomes after total pancreatectomy for all indications, except chronic pancreatitis. PubMed, EMBASE (Ovid), and Cochrane Library were searched (2005-2018). Endpoints included functional outcome and QoL.
RESULTS
A total of 21 studies, including 1536 patients, fulfilled the eligibility criteria. During a median follow-up of 20·8 (range 1·5-96·0) months, 18·6 per cent (45 of 242 patients) were readmitted for endocrine-related morbidity, with associated mortality in 1·6 per cent (6 of 365 patients). No diabetes-related mortality was reported in studies including only patients treated after 2005. Symptoms related to exocrine insufficiency were reported by 43·5 per cent (143 of 329 patients) during a median follow-up of 15·9 (1·5-96·0) months. Overall QoL, reported by 102 patients with a median follow-up of 28·6 (6·0-66·0) months, using the EORTC QLQ-C30 questionnaire, showed a moderately reduced summary score of 76 per cent, compared with a general population score of 86 per cent (P = 0·004).
CONCLUSION
Overall QoL after total pancreatectomy is affected adversely, in particular by the considerable impact of diarrhoea that requires better treatment. There is also room for improvement in the management of diabetes after total pancreatectomy, particularly with regards to prevention of diabetes-related morbidity.
Topics: Humans; Pancreatectomy; Pancreatic Neoplasms; Postoperative Period; Quality of Life; Recovery of Function
PubMed: 31502658
DOI: 10.1002/bjs.11296 -
Cancers Sep 2023Parenchymal-sparing approaches to pancreatectomy are technically challenging procedures but allow for preserving a normal pancreas and decreasing the rate of... (Review)
Review
BACKGROUND
Parenchymal-sparing approaches to pancreatectomy are technically challenging procedures but allow for preserving a normal pancreas and decreasing the rate of postoperative pancreatic insufficiency. The robotic platform is increasingly being used for these procedures. We sought to evaluate robotic parenchymal-sparing pancreatectomy and assess its complication profile and efficacy.
METHODS
This systematic review consisted of all studies on robotic parenchymal-sparing pancreatectomy (central pancreatectomy, duodenum-preserving partial pancreatic head resection, enucleation, and uncinate resection) published between January 2001 and December 2022 in PubMed and Embase.
RESULTS
A total of 23 studies were included in this review ( = 788). Robotic parenchymal-sparing pancreatectomy is being performed worldwide for benign or indolent pancreatic lesions. When compared to the open approach, robotic parenchymal-sparing pancreatectomies led to a longer average operative time, shorter length of stay, and higher estimated intraoperative blood loss. Postoperative pancreatic fistula is common, but severe complications requiring intervention are exceedingly rare. Long-term complications such as endocrine and exocrine insufficiency are nearly nonexistent.
CONCLUSIONS
Robotic parenchymal-sparing pancreatectomy appears to have a higher risk of postoperative pancreatic fistula but is rarely associated with severe or long-term complications. Careful patient selection is required to maximize benefits and minimize morbidity.
PubMed: 37686648
DOI: 10.3390/cancers15174369 -
Endocrine Journal 2015Islet autotransplantation (IAT) is a viable treatment for patients with severe chronic pancreatitis, this modality may prevent brittle diabetes mellitus after... (Meta-Analysis)
Meta-Analysis Review
Islet autotransplantation (IAT) is a viable treatment for patients with severe chronic pancreatitis, this modality may prevent brittle diabetes mellitus after pancreatectomy. This systematic review and meta-analysis was performed to evaluated the outcomes of IAT after TP and discuss the factors that may affect the efficacy of this procedure. MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1977 to 30 April 2014. Cohort Studies reported patients with IAT after TP were included. The studies and data were identified and extracted by two reviewers independently. Data were analyzed using STATA 12.0 and Comprehensive Meta AnalysisV2 software. Random effects model, meta-regression analysis, sensitivity analysis and publication bias were conducted to improve the comprehensive analysis. Twelve studies reporting the outcomes of 677 patients were included in this review. The insulin independent rate for IAT after TP at last follow-up was 3.72 per 100 person-years (95% CI: 1.00-6.44). The 30-day mortality was 2.1% (95% CI: 1.2-3.8%). The mortality at last follow-up was 1.09 per 100 person-years (95% CI: 0.21-1.97). Factors associated with incidence density of insulin independence in univariate meta-regression analyses included islet equivalents per kg body weight (IEQ/kgBW) (P=0.026). Our systematic review suggests that IAT is a safe modality for patients with CP need to undergo TP. A significant number of patients will achieve insulin independence for a long time after receiving enough IEQ/kgBW.
Topics: Humans; Islets of Langerhans Transplantation; Pancreatectomy; Pancreatitis, Chronic; Transplantation, Autologous; Treatment Outcome
PubMed: 25735805
DOI: 10.1507/endocrj.EJ14-0510 -
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 -
Surgical Endoscopy Jun 2023Robot-assisted distal pancreatectomy (RDP) has been suggested to hold some benefits over laparoscopic distal pancreatectomy (LDP) but consensus and data on specific... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Robot-assisted distal pancreatectomy (RDP) has been suggested to hold some benefits over laparoscopic distal pancreatectomy (LDP) but consensus and data on specific subgroups are lacking. This systematic review and meta-analysis reports the surgical and oncological outcome and costs between RDP and LDP including subgroups with intended spleen preservation and pancreatic ductal adenocarcinoma (PDAC).
METHODS
Studies comparing RDP and LDP were included from PubMed, Cochrane Central Register, and Embase (inception-July 2022). Primary outcomes were conversion and unplanned splenectomy. Secondary outcomes were R0 resection, lymph node yield, major morbidity, operative time, intraoperative blood loss, in-hospital mortality, operative costs, total costs and hospital stay.
RESULTS
Overall, 43 studies with 6757 patients were included, 2514 after RDP and 4243 after LDP. RDP was associated with a longer operative time (MD = 18.21, 95% CI 2.18-34.24), less blood loss (MD = 54.50, 95% CI - 84.49-24.50), and a lower conversion rate (OR = 0.44, 95% CI 0.36-0.55) compared to LDP. In spleen-preserving procedures, RDP was associated with more Kimura procedures (OR = 2.23, 95% CI 1.37-3.64) and a lower rate of unplanned splenectomies (OR = 0.32, 95% CI 0.24-0.42). In patients with PDAC, RDP was associated with a higher lymph node yield (MD = 3.95, 95% CI 1.67-6.23), but showed no difference in the rate of R0 resection (OR = 0.96, 95% CI 0.67-1.37). RDP was associated with higher total (MD = 3009.31, 95% CI 1776.37-4242.24) and operative costs (MD = 3390.40, 95% CI 1981.79-4799.00).
CONCLUSIONS
RDP was associated with a lower conversion rate, a higher spleen preservation rate and, in patients with PDAC, a higher lymph node yield and similar R0 resection rate, as compared to LDP. The potential benefits of RDP need to be weighed against the higher total and operative costs in future randomized trials.
Topics: Humans; Robotics; Robotic Surgical Procedures; Pancreatectomy; Treatment Outcome; Pancreatic Neoplasms; Carcinoma, Pancreatic Ductal; Laparoscopy; Operative Time; Length of Stay; Retrospective Studies
PubMed: 36781467
DOI: 10.1007/s00464-023-09894-y -
HPB : the Official Journal of the... Nov 2012Currently, laparoscopic distal pancreatectomy (LDP) is regarded as a safe and effective surgical approach for lesions in the body and tail of the pancreas. This review... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Currently, laparoscopic distal pancreatectomy (LDP) is regarded as a safe and effective surgical approach for lesions in the body and tail of the pancreas. This review compares outcomes of the laparoscopic technique with those of open distal pancreatectomy (ODP) and assesses the efficacy, safety and feasibility of each type of procedure.
METHODS
Comparative studies published between January 1996 and April 2012 were included. Studies were selected based on specific inclusion and exclusion criteria. Evaluated endpoints were operative outcomes, postoperative recovery and postoperative complications.
RESULTS
Fifteen non-randomized comparative studies that recruited a total of 1456 patients were analysed. Rates of conversion from LDP to open surgery ranged from 0% to 30%. Patients undergoing LDP had less intraoperative blood loss [weighted mean difference (WMD) -263.36.59 ml, 95% confidence interval (CI) -330.48 to -196.23 ml], fewer blood transfusions [odds ratio (OR) 0.28, 95% CI 0.11-0.76], shorter hospital stay (WMD -4.98 days, 95% CI -7.04 to -2.92 days), a higher rate of splenic preservation (OR 2.98, 95% CI 2.18-3.91), earlier oral intake (WMD -2.63 days, 95% CI -4.23 to 1.03 days) and fewer surgical site infections (OR 0.37, 95% CI 0.18-0.75). However, there were no differences between the two approaches with regard to operation time, time to first flatus and the occurrence of pancreatic fistula and other postoperative complications.
CONCLUSIONS
Laparoscopic resection results in improved operative and postoperative outcomes compared with open surgery according to the results of the present meta-analyses. It may be a safe and feasible option for patients with lesions in the body and tail of the pancreas. However, randomized controlled trials should be undertaken to confirm the relevance of these early findings.
Topics: Chi-Square Distribution; Humans; Laparoscopy; Odds Ratio; Pancreatectomy; Pancreatic Diseases; Postoperative Complications; Recovery of Function; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 23043660
DOI: 10.1111/j.1477-2574.2012.00531.x -
United European Gastroenterology Journal Oct 2020Individuals with a very high lifetime risk of developing pancreatic ductal adenocarcinoma; for example, hereditary pancreatitis and main-duct or mixed-type intraductal...
Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision-making programme using decision tables.
BACKGROUND
Individuals with a very high lifetime risk of developing pancreatic ductal adenocarcinoma; for example, hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm, may wish to discuss prophylactic total pancreatectomy but strategies to do so are lacking.
OBJECTIVE
To develop a shared decision-making programme for prophylactic total pancreatectomy using decision tables.
METHODS
Focus group meetings with patients were used to identify relevant questions. Systematic reviews were performed to answer these questions.
RESULTS
The first tables included hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm. No studies focused on prophylactic total pancreatectomy in these groups. In 52 studies (3570 patients), major morbidity after total pancreatectomy was 25% and 30-day mortality was 6%. After minimally invasive total pancreatectomy (seven studies, 35 patients) this was, respectively, 13% and 0%. Exocrine insufficiency-related symptoms occurred in 33%. Quality of life after total pancreatectomy was slightly lower compared with the general population.
CONCLUSION
The decision tables can be helpful for discussing prophylactic total pancreatectomy with individuals at high risk of pancreatic ductal adenocarcinoma.
Topics: Carcinoma, Pancreatic Ductal; Decision Making, Shared; Decision Support Techniques; Disease Progression; Exocrine Pancreatic Insufficiency; Humans; Pancreatectomy; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatitis, Chronic; Postoperative Complications; Prophylactic Surgical Procedures; Quality of Life; Risk Assessment; Treatment Outcome
PubMed: 32703081
DOI: 10.1177/2050640620945534