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?

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

Abstract

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.

Details

OriginalspracheEnglisch
Seiten (von - bis)e702-e711
FachzeitschriftAnnals of surgery
Jahrgang278
Ausgabenummer4
PublikationsstatusVeröffentlicht - 1 Okt. 2023
Peer-Review-StatusJa

Externe IDs

PubMedCentral PMC10481933
Scopus 85167514379

Schlagworte

Schlagwörter

  • Humans, Pancreatectomy/adverse effects, Pancreaticoduodenectomy/adverse effects, Pancreatic Fistula/epidemiology, Quality of Life, Pancreas/surgery, Postoperative Complications/prevention & control