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Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis

查看全文 作　　者：Ionut [1]Negoi;Sorin [2]Hostiuc;Alexandru [1]Runcanu;Ruxandra Irina [3]Negoi;Mircea [1]Beuran 高影响力作者 机构地区：[1]General Surgery Department, Emergency Hospital of Bucharest;[2]National Institute of Legal Medicine Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania;[3]Anatomy Department,Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania高影响力机构 出　　处：《Hepatobiliary & Pancreatic Diseases International》索引2017年第16卷第2期,共12页高影响力期刊 摘　　要：BACKGROUND: The superior mesenteric artery(SMA) first approach was proposed recently as a new modification of the standard pancreaticoduodenectomy. Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenectomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pancreaticoduodenectomy(SMA-PD) with standard pancreaticoduodenectomy(S-PD).DATA SOURCES: Electronic search of the PubM ed/MEDLINE, EMBASE, Web of Science and Cochrane Library was performed until July 2015. We considered randomized controlled trials(RCTs) and non-randomized comparative studies(NRCSs) comparing SMA-PD with S-PD to be eligible if they included patients with periampullary cancers.RESULTS: A total of one RCT and thirteen NRCSs met the inclusion criteria, involving 640 patients with SMA-PD and 514 patients with S-PD. The SMA-PD was associated with less intraoperative bleeding, less blood transfusions and higher rate of associated venous resections. The pancreatic fistula and delayed gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complication rates and in-hospital mortality. There was no difference regarding R0 resection rate, and one-, two-or three-year over-all survival. The SMA-PD was associated with a lower local, hepatic and extrahepatic metastatic rate.CONCLUSIONS: The SMA-PD is associated with better perioperative outcomes, such as blood loss, transfusion requirements, pancreatic fistula, and delayed gastric emptying. Although the one-, two-or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic recurrence rate. 关 键 词：十二指肠 切除术 肠系膜 标准 动脉 随机对照试验 MEDLINE 系统
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