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- Title
Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival.
- Authors
Ironside, N.; Barreto, S. G.; Loveday, B.; Shrikhande, S. V.; Windsor, J. A.; Pandanaboyana, S.
- Abstract
Background: The aim of this systematic review andmeta-analysis was to evaluate perioperative outcomes and survival in patients undergoing an artery-first approach to pancreatoduodenectomy in comparison with those having standard pancreatoduodenectomy. Methods: A systematic search of PubMed, MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed in accordance with PRISMA guidelines. Comparative studies including patients who underwent artery-first pancreatoduodenectomy and standard pancreatoduodenectomy were analysed. Results: Seventeen studies were included in the final analysis. There were 16 retrospective cohort or case-control studies and one RCT. A total of 1472 patients were included in the meta-analysis, of whom 771 underwent artery-first pancreatoduodenectomy and 701 had standard pancreatoduodenectomy. Intraoperative blood loss (mean difference -389 ml; P <0.001) and the proportion of patients requiring intraoperative transfusion (10.6 per cent (54 of 508) versus 40.1 per cent (186 of 464); P <0.001) were significantly lower in the artery-first group. Although rates of perioperative mortality were comparable between the two groups, perioperative morbidity (35.5 per cent (263 of 741) versus 44.3 per cent (277 of 625); P = 0.002), and the incidence of grade B/C pancreatic fistula (7.4 per cent (26 of 353) versus 12.8 per cent (42 of 327); P = 0.031) were significantly lower in the artery-first group. The R0 resection rate (75.8 per cent (269 of 355) versus 67.0 per cent (280 of 418); P <0.001) and overall survival (hazard ratio 0.72, 95 per cent c.i. 0.60 to 0.87; P <0.001) were significantly higher in the artery-first group. Conclusion: The artery-first approach to pancreatoduodenectomy may be associated with improved perioperative outcomes and survival.
- Subjects
PANCREATICODUODENECTOMY; PERIOPERATIVE care; META-analysis; MEDICAL care; DUODENECTOMY
- Publication
British Journal of Surgery, 2018, Vol 105, Issue 6, p628
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1002/bjs.10832