Abstract
BackgroundAlthough pancreaticoduodenectomy with vein resection (PDVR) is widely performed in selected patients with indications, its benefits remain controversial. In this meta-analysis, we evaluate the safety and efficacy of PDVR in comparison to standard pancreaticoduodenectomy (PD).MethodsWe searched PubMed, Embase, and Cochrane as well as the Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases for studies that evaluate the value of PVDR. The data of the patients who underwent PD or PDVR were analyzed using Review Manager and STATA software.ResultsIn comparison with the PD group, the PDVR group had a lower R0 resection rate and higher rates of complications such as biliary fistula, reoperation rate, delayed gastric emptying, cardiopulmonary abnormalities, hemorrhage, in-hospital mortality, 30-day mortality. The blood loss, duration of operation, total hospital stay is higher in PDVR group.ConclusionsCompared to standard PD, PDVR was associated with a greater risk of some specific complications and increase the mortality rate, total hospital stay time, combine with vein resection have a lower R0 resection rate. Therefore, combine with vascular resection for pancreatic cancer needs to be carefully selected by the surgeon.
Highlights
Pancreaticoduodenectomy with vein resection (PDVR) is widely performed in selected patients with indications, its benefits remain controversial
Further complications arise if the tumor invades major vascular structures adjacent to the pancreatic head, such as the portal vein (PV) and superior mesenteric vein
Studies have shown that the median overall survival of patients undergoing PVDR for borderline and locally advanced pancreatic cancer is 22 to 24.9 months [7, 8]
Summary
Pancreaticoduodenectomy with vein resection (PDVR) is widely performed in selected patients with indications, its benefits remain controversial. To ensure that the post-resection surgical margin of the tumor is negative for cancer cells (R0 resection), the use of PD is restricted to patients who have no borderline resectable lesions or locally unresectable lesions and have no metastatic disease [3, 4]. Another point in consideration is that only 15–20% of patients are candidates for surgical resection, after careful pre-therapeutic evaluation [1]. Other studies have evaluated the risk of surgery and the overall survival outcomes and concluded that an operative intervention for patients with pancreatic cancer is not favorable
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