The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies
<i>Background:</i> The literature is conflicting regarding oncological outcome and morbidity associated to portal–mesenteric resection during pancreaticoduodenectomy (PD) in patients with pancreatic head adenocarcinoma (PHAC). <i>Methods:</i> A meta-analysis of studies compar...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-07-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/12/7/1976 |
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| author | Alessandro Fancellu Niccolò Petrucciani Alberto Porcu Giulia Deiana Valeria Sanna Chiara Ninniri Teresa Perra Valentina Celoria Giuseppe Nigri |
| author_facet | Alessandro Fancellu Niccolò Petrucciani Alberto Porcu Giulia Deiana Valeria Sanna Chiara Ninniri Teresa Perra Valentina Celoria Giuseppe Nigri |
| author_sort | Alessandro Fancellu |
| collection | DOAJ |
| description | <i>Background:</i> The literature is conflicting regarding oncological outcome and morbidity associated to portal–mesenteric resection during pancreaticoduodenectomy (PD) in patients with pancreatic head adenocarcinoma (PHAC). <i>Methods:</i> A meta-analysis of studies comparing PD plus venous resection (PD+VR) and standard PD exclusively in patients with adenocarcinoma of the pancreatic head was conducted. <i>Results:</i> Twenty-three cohort studies were identified, which included 6037 patients, of which 28.6% underwent PD+VR and 71.4% underwent standard PD. Patients who received PD+VR had lower 1-year overall survival (OS) (odds radio OR 0.79, 95% CI 0.67–0.92, <i>p</i> = 0.003), 3-year OS (OR 0.72, 95% CI 0.59–0.87, <i>p</i> = 0.0006), and 5-year OS (OR 0.57, 95% CI 0.39–0.83, <i>p</i> = 0.003). Patients in the PD+VR group were more likely to have a larger tumor size (MD 3.87, 95% CI 1.75 to 5.99, <i>p</i> = 0.0003), positive lymph nodes (OR 1.24, 95% CI 1.06–1.45, <i>p</i> = 0.007), and R1 resection (OR 1.74, 95% CI 1.37–2.20, <i>p</i> < 0.0001). Thirty-day mortality was higher in the PD+VR group (OR 1.93, 95% CI 1.28–2.91, <i>p</i> = 0.002), while no differences between groups were observed in rates of total complications (OR 1.07, 95% CI, 0.81–1.41, <i>p</i> = 0.65)<i>. Conclusions:</i> Although PD+VR has significantly increased the resection rate in patients with PHAC, it has inferior survival outcomes and higher 30-day mortality when compared with standard PD, whereas postoperative morbidity rates are similar. Further research is needed to evaluate the role of PD+VR in the context of multimodality treatment of PHAC. |
| first_indexed | 2024-03-10T18:20:29Z |
| format | Article |
| id | doaj.art-0da418242e00432fbf27222674388e60 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T18:20:29Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
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| series | Cancers |
| spelling | doaj.art-0da418242e00432fbf27222674388e602023-11-20T07:21:12ZengMDPI AGCancers2072-66942020-07-01127197610.3390/cancers12071976The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative StudiesAlessandro Fancellu0Niccolò Petrucciani1Alberto Porcu2Giulia Deiana3Valeria Sanna4Chiara Ninniri5Teresa Perra6Valentina Celoria7Giuseppe Nigri8Unit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, ItalyDepartment of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, ItalyUnit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, ItalyUnit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, ItalyUnit of Medical Oncology, AOU Sassari, Via E. De Nicola, 07100 Sassari, ItalyUnit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, ItalyUnit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, ItalyUnit of General Surgery 2—Clinica Chirurgica, Department of Medical Surgical and Experimental Sciences, University of Sassari, V. le San Pietro 43, 07100 Sassari, ItalyDepartment of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy<i>Background:</i> The literature is conflicting regarding oncological outcome and morbidity associated to portal–mesenteric resection during pancreaticoduodenectomy (PD) in patients with pancreatic head adenocarcinoma (PHAC). <i>Methods:</i> A meta-analysis of studies comparing PD plus venous resection (PD+VR) and standard PD exclusively in patients with adenocarcinoma of the pancreatic head was conducted. <i>Results:</i> Twenty-three cohort studies were identified, which included 6037 patients, of which 28.6% underwent PD+VR and 71.4% underwent standard PD. Patients who received PD+VR had lower 1-year overall survival (OS) (odds radio OR 0.79, 95% CI 0.67–0.92, <i>p</i> = 0.003), 3-year OS (OR 0.72, 95% CI 0.59–0.87, <i>p</i> = 0.0006), and 5-year OS (OR 0.57, 95% CI 0.39–0.83, <i>p</i> = 0.003). Patients in the PD+VR group were more likely to have a larger tumor size (MD 3.87, 95% CI 1.75 to 5.99, <i>p</i> = 0.0003), positive lymph nodes (OR 1.24, 95% CI 1.06–1.45, <i>p</i> = 0.007), and R1 resection (OR 1.74, 95% CI 1.37–2.20, <i>p</i> < 0.0001). Thirty-day mortality was higher in the PD+VR group (OR 1.93, 95% CI 1.28–2.91, <i>p</i> = 0.002), while no differences between groups were observed in rates of total complications (OR 1.07, 95% CI, 0.81–1.41, <i>p</i> = 0.65)<i>. Conclusions:</i> Although PD+VR has significantly increased the resection rate in patients with PHAC, it has inferior survival outcomes and higher 30-day mortality when compared with standard PD, whereas postoperative morbidity rates are similar. Further research is needed to evaluate the role of PD+VR in the context of multimodality treatment of PHAC.https://www.mdpi.com/2072-6694/12/7/1976pancreaticoduodenectomyportal-mesenteric resectionsurvivalcomplications |
| spellingShingle | Alessandro Fancellu Niccolò Petrucciani Alberto Porcu Giulia Deiana Valeria Sanna Chiara Ninniri Teresa Perra Valentina Celoria Giuseppe Nigri The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies Cancers pancreaticoduodenectomy portal-mesenteric resection survival complications |
| title | The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies |
| title_full | The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies |
| title_fullStr | The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies |
| title_full_unstemmed | The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies |
| title_short | The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies |
| title_sort | impact on survival and morbidity of portal mesenteric resection during pancreaticoduodenectomy for pancreatic head adenocarcinoma a systematic review and meta analysis of comparative studies |
| topic | pancreaticoduodenectomy portal-mesenteric resection survival complications |
| url | https://www.mdpi.com/2072-6694/12/7/1976 |
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