根治性顺行模块化胰脾切除术治疗胰体尾癌安全性与有效性的Meta分析

Safety and oncological outcomes of radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer:a meta-analysis

目的:应用Meta分析系统评价根治性顺行模块化胰脾切除术(RAMPS)治疗胰体尾癌的安全性与有效性。方法:全面检索PubMed、Embase、MEDLINE、Web of Science、万方、中国知网、The Cochrane Library(Cochrane Database of Systematic Reviews)、Cochrane Central Register of Controlled Trials(CENTRAL)等数据库在2019年7月19日前发表的中、英文文献,筛选高质量文章,然后通过RevMan软件完成Meta分析,评价RAMPS手术及标准逆行性胰体尾脾切除术(SRPS)治疗胰体尾癌的安全性与有效性。结果:本Meta分析共纳入10项临床研究,入组601例胰体尾癌患者(RAMPS组229例,SRPS组372例)。Meta分析结果显示,与SRPS组相比,RAMPS组具有较好的安全性,两组手术时间、术中出血量、总并发症发生率、术后胰瘘发生率及术后住院时间差异均无统计学意义,亚组分析中,将纳入回顾性研究以固定效应模型进行分析时,结果显示RAMPS组具有更少的术中出血量(95%CI:-144.78^-99.94;I 2=95%,P<0.001)。有效性评价结果显示,与SRPS手术相比,RAMPS可显著提高胰体尾癌的R0切除率(95%CI:1.67~4.82,I 2=0,P<0.001)、淋巴结清扫数量(95%CI:2.85~6.08,I 2=51%,P<0.001),并显著降低术后复发转移率(95%CI:0.37~0.84,I 2=0,P=0.005),提高总生存期(HR=0.71,95%CI:0.53~0.96,I 2=0,P=0.02),但两组患者术后无病生存期差异无统计学意义。结论:RAMPS具备较好的安全性与可行性,并未增加手术风险,对于胰体尾癌患者,RAMPS能提高肿瘤根治程度并降低术后复发转移率,最终提高患者总生存期,具有较好的临床应用价值。

Objective:To evaluate the safety and oncological outcomes of radical antegrade modular pancreatosplenectomy(RAMPS)for treatment of left-sided pancreatic cancer systematically by meta-analysis.Methods:A comprehensive literature review of studies,which published on PubMed,Embase,MEDLINE,Web of Science,WanFang,CNKI,the Cochrane Library(Cochrane Database of Systematic Reviews),and Cochrane Central Register of Controlled Trials(CENTRAL)before July 19,2019,was performed to identify all the well-designed clinical trials on the comparison of the feasibility and oncological outcome of RAMPS and standard retrograde pancreatosplenectomy(SRPS)for treatment of left-sided pancreatic cancer.Revman 5.3 was used to perform the meta-analysis.Results:Ten studies containing 601 patients(229 RAMPS and 372 SRPS)with left-sided pancreatic cancer were included for the analysis.Meta-analysis revealed that RAMPS was safe and feasible for left-sided pancreatic cancer patients,with no significant difference of operation time,intraoperative blood loss,overall postoperative complications and pancreatic fistula rate,and hospital stay after operation,when compared with SRPS group.Moreover,subgroup analysis used fixed effect model for all the retrospective studies,the results showed that RAMPS was associated with significantly less blood loss(95%CI:-144.78^-99.94;I 2=95%,P<0.001).For comparison of the oncological outcomes,meta-analysis showed that RAMPS procedure was correlated with significantly higher R0 rate(95%CI:1.67~4.82,I 2=0,P<0.001),more harvested lymph node(95%CI:2.85~6.08,I 2=51%,P<0.001),lower recurrence rate(95%CI:0.37~0.84,I 2=0,P=0.005)and better overall survival(HR=0.71,95%CI:0.53~0.96,I 2=0,P=0.02).However,no statistically significant difference was found between the procedures with respect to disease free survival.Conclusions:RAMPS is a safe and feasible procedure without additional perioperative risks when compared with traditional SRPS.For patients with left-sided pancreatic cancer,RAMPS improves the oncological outcomes with higher R0 rate,more harvested lymph nodes,and lower recurrence rate,as well as a better overall survival.