Effectiveness and safety of central pancreatectomy in benign or low-grade malignant pancreatic body lesions: a systematic review and meta-analysis.

Abstract

The best approach for treating benign or low-grade malignant lesions localized in the pancreatic neck or body remains debatable. Conventional pancreatoduodenectomy and distal pancreatectomy (DP) are associated with a risk of impairment of pancreatic function at long-term follow-up. With advances in technology and surgical skills, the use of central pancreatectomy (CP) has gradually increased. To compare the safety, feasibility, and short-term and long-term clinical benefits of CP and DP in matched cases. The PubMed, MEDLINE, Web of Science, Cochrane, and EMBASE databases were systematically searched to identify studies published from database inception to February 2022 that compared CP and DP. This meta-analysis was performed using R software. Twenty-six studies matched the selection criteria, including 774 CP and 1713 DP cases. CP was associated with significantly higher rates of operative time (P<0.0001), blood loss (P<0.01), overall and clinically relevant pancreatic fistula (P<0.01), postoperative hemorrhage (P<0.0001), reoperation (P=0.0196), delayed gastric emptying (P=0.0096), hospital stay (P<0.01), and morbidity (P<0.0001) but with a significantly lower incidence of overall endocrine and exocrine insufficiency (P<0.0001), and new-onset (P<0.0001) and worsening diabetes mellitus (P<0.0001) than DP. CP should be considered as an alternative to DP in selected cases such as without pancreatic disease, length of the residual distal pancreas ≥5cm, branch-duct IPMNs, and a low risk of POPF after adequate evaluation.