Overall Postoperative Morbidity and Pancreatic Fistula Are Relatively Higher after Central Pancreatectomy than Distal Pancreatic Resection: A Systematic Review and Meta-Analysis. (22nd February 2020)

• Record Type: Journal Article
• Authors: Regmi, Parbatraj; Yang, Qing; Hu, Hai-Jie; Liu, Fei; Karn, Hare Ram; Ma, Wen-Jie; Ran, Cong-Dun; Li, Fu-Yu
• Other Names: Serra Raffaele Academic Editor.
• Is Part Of: BioMed research international. Volume 2020(2020)
• Publication Date: 2020-02-22
• Subjects: Medicine -- Periodicals; Biology -- Periodicals; Biotechnology -- Periodicals; Life sciences -- Periodicals; 610.5
• DOI: 10.1155/2020/7038907
• Languages: English
• ISSNs: 2314-6133

Abstract

Abstract : Objective . To compare the intraoperative and postoperative outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). Methods . A systematic literature search was performed on electronic databases from MEDLINE, Embase, and PubMed from 1998 to 2018. Statistical analysis and meta-analysis were performed using statistics/data analysis (Stata®) software, version 12.0 (StataCorp LP, College Station, Texas 77845, USA). Dichotomous variables were analyzed by estimation of relative risk (RR) with a 95 percent (%) confidence interval (CI) and continuous variables were analyzed by standardized mean differences (SMD) with 95% CI. Results . Twenty-four studies with 593 CP and 1226 DP were included in the meta-analysis. CP had significantly longer operation time (SMD: 1.03; 95% CI 0.62 to 1.44; P < 0.001 ) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.01 ). Estimated blood loss was significantly lower in CP (SMD: −0.34; 95% CI −0.58 to −0.09; P = 0.007 ). Overall postoperative morbidity (RR: 1.30; 95% CI: 1.13 to 1.50; P < 0.001 ), overall pancreatic fistula (RR: 1.41; 95% CI: 1.20 to 1.66; P < 0.001 ), clinically relevant fistula (RR: 1.64; 95% CI: 1.25 to 2.16; P < 0.001 ), and postoperative hemorrhage (RR: 1.90; 95% CI: 1.18 to 3.06; P < 0.05 ) were all significantly higher after CP. On long-term follow-up, DP patients were more likely to have postoperative exocrine (RR: 0.56; 95% CI: 0.37 to 0.84; P < 0.05 ) and endocrine (RR: 0.27; 95% CI: 0.18 to 0.40; P < 0.001 ) insufficiency. There was no statistically significant difference in transfusion requirement, postoperative mortality, reoperation, and tumor recurrence. Conclusion . CP is associated with significantly higher morbidity and clinically relevant pancreatic fistula. CP should only be reserved for selected patients who require postoperative pancreatic function preservation.