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Meta-Analysis
. 2021 Oct 8;100(40):e27438.
doi: 10.1097/MD.0000000000027438.

The impact of venous resection in pancreatoduodectomy: A systematic review and meta-analysis

João Emílio Lemos Pinheiro Filho  1 , Francisco Tustumi  1   2 , Fabricio Ferreira Coelho  1   2 , Sérgio Silveira Júnior  1   2 , Fernanda Cavalcanti Cabral Honório  1 , Alexandre Cruz Henriques  1 , André Roncon Dias  1   2 , Jaques Waisberg  1
Affiliations
Meta-Analysis

The impact of venous resection in pancreatoduodectomy: A systematic review and meta-analysis

João Emílio Lemos Pinheiro Filho et al. Medicine (Baltimore). .

Abstract

Background: Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial.

Objective: This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD).

Methods: A systematic review and meta-analysis of studies comparing VRPD and PD were performed.

Results: VRPD was associated with a higher risk for postoperative mortality (risk difference: -0.01; 95% confidence interval [CI] -0.02 to -0.00) and complications (risk difference: -0.05; 95% CI -0.09 to -0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: -0.65; 95% CI -2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: -69.09; 95% CI -88.4 to -49.78), with a higher blood loss rate (MD: -314.04; 95% CI -423.86 to -195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03-1.23).

Conclusion: VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Short-term outcomes of venous resection pancreatoduodenectomy compared to standard pancreatoduodenectomy. A) Complications; B) perioperative mortality. CI = confidence interval.
Figure 2
Figure 2
Short-term outcomes of venous resection pancreatoduodenectomy compared to standard pancreatoduodenectomy. A) Length of hospital stay; B) operative time. CI = confidence interval.
Figure 3
Figure 3
Short-term outcomes of venous resection pancreatoduodenectomy compared to standard pancreatoduodenectomy. A) Compromised margins; B) estimated blood loss. CI = confidence interval.
Figure 4
Figure 4
Long-term survival analysis of venous resection pancreatoduodenectomy compared to standard pancreatoduodenectomy. CI = confidence interval.
See this image and copyright information in PMC

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