胰腺癌联合动脉切除术的安全性与疗效Meta分析

A Meta-analysis of arterial resection during pancreatectomy for pancreatic cancer

目的系统评价胰腺切除术中采用联合动脉切除对围术期风险及预后的影响。方法在PubMed、Embase、The Cochrane Library、知网、万方数据库中检索所有比较联合动脉切除的胰腺切除和单纯胰腺切除的回顾性队列研究。按照拟定的纳入标准与排除标准对文献进行筛选;文献质量评价参考纽卡斯尔-渥太华量表标准进行评价;Meta分析运用RevMan 5.2版软件,采用固定模型分析。结果共纳入13篇文献。Meta分析结果显示:与单纯胰腺切除组相比,联合动脉切除组总并发症发生率更高(OR 1.66,95%CI 1.25~2.21,P=0.0005),围术期病死率更高(OR 2.91,95%CI 1.43~5.95,P=0.003),术中输血率更高(OR 2.72,95%CI 1.75~4.23,P<0.00001),切缘阴性率更低(OR 0.45,95%CI 0.31~0.65,P<0.0001),术后生存率更低(1年:OR 0.57,95%CI 0.39~0.84,P=0.005;3年:OR 0.37,95%CI 0.21~0.65,P=0.0006)。结论本次Meta分析表明,胰腺癌联合动脉切除术将面临更高的围术期风险和更差的生存率,需谨慎、有针对性地应用该技术。

Objective To evaluate the perioperative and long-term outcomes of patients with arterial resection(AR)during pancreatectomy for pancreatic cancer.Methods All retrospective cohort studies comparing pancreatectomy combined with arterial resection(AR)and simple pancreatectomy were searched in PubMed,Embase,The Cochrane Library,CNKI and Wanfang databases.The literatures were screened according to inclusion and exclusion criteria.Quality assessment was conducted according to Newcastle-Ottawa Scale.Meta-analyses were carried out with RevMan 5.2 version software and were performed with a fixed effects model comparing patients with or without AR in pancreatectomy.Results The literature search identified 13 studies including 301 and 2792 patients who underwent pancreatectomy with and without AR.All studies were retrospective cohort studies.Meta-analyses revealed that AR was associated with a significantly increased risk for perioperative morbidity(OR 1.66,95%CI 1.25~2.21,P=0.0005),perioperative mortality(OR 2.91,95%CI 1.43~5.95,P=0.003),blood transfusion during operation(OR 2.91,95%CI 1.75~4.23,P=0.003);and with lower R0 resection(OR 0.45,95%CI 0.31~0.65,P<0.0001),lower survival rate at 1 year(OR 0.57,95%CI 0.39~0.84,P=0.005)and 3 year(OR 0.37,95%CI 0.21~0.65,P=0.0006).Conclusion AR in patients undergoing pancreatectomy for pancreatic cancer is associated with higher perioperative risk and lower survival rate,which needs to be applied cautiously in targeted patients.