动脉优先入路与标准入路胰十二指肠切除术近远期疗效比较的meta分析

Short-term and long-term efficacy of artery-first approach versus standard approach pancreaticoduodenectomy:a meta-analysis

目的比较动脉优先入路胰十二指肠切除术(AF-PD)与标准入路胰十二指肠切除术(S-PD)的近远期疗效。方法检索PubMed、EMbase、The Cochrane Library、Web of Science、CBM、WanFang和CNKI数据库,纳入相关文献,提取数据进行meta分析。结果共纳入了30篇文献共计2750例患者。meta分析结果显示:在近期疗效方面,与S-PD组比较,AF-PD组术中出血量更少(WMD=-175.87,P<0.001)、术中输血率更低(OR=0.36,P=0.002)、R0切除率更高(OR=1.83,P<0.001)、术后胰瘘发生率更低(OR=0.71,P=0.005)、术后住院时间更短(WMD=-2.69,P=0.007),但2组的手术时间和术后总体并发症发生率的差异均无统计学意义(P>0.05)。在远期疗效方面,与S-PD组比较,AF-PD组的术后肿瘤局部复发率(OR=0.43,P=0.004)和肿瘤肝转移率更低(OR=0.60,P=0.010),1年(OR=1.95,P=0.007)、2年(OR=2.04,P<0.001)、3年(OR=2.09,P=0.001)及5年(OR=2.06,P=0.003)总体生存率均更高,但2组的肿瘤肺转移率和腹膜转移率的差异均无统计学意义(P>0.05)。结论AF-PD的R0切除率、胰瘘发生率、总体生存率等近远期结局指标优于S-PD,但因本研究纳入文献质量的限制,结论仍需未来更多高质量研究予以验证。

Objective To compare the short-and long-term efficacy of artery-first approach pancreaticoduodenectomy(AF-PD)and standard approach pancreaticoduodenectomy(S-PD).Methods The PubMed,EMbase,The Cochrane Library,Web of Science,CBM,WanFang,and CNKI databases were searched,relevant literatures were included,and relevant data were extracted for meta-analysis.Results A total of 30 articles were included,including 2750 cases underwent pancreaticoduodenectomy.The results of meta-analysis showed that in terms of short-term efficacy when compared with S-PD group,the AF-PD group had less intraoperative blood loss(WMD=–175.87,P<0.001),lower intraoperative blood transfusion rate(OR=0.36,P=0.002),higher R0 resection rate(OR=1.83,P<0.001),lower postoperative pancreatic leakage rate(OR=0.71,P=0.005),and shorter postoperative hospital stay(WMD=–2.69,P=0.007).However,there were no statistically significant differences in the operation time and overall postoperative complication rate between the two groups(P>0.05).In terms of long-term efficacy when compared with S-PD group,the AF-PD group had lower tumor local recurrence rate(OR=0.43,P=0.004)and tumor liver metastasis rate(OR=0.60,P=0.010),but had higher 1-year(OR=1.95,P=0.007),2-year(OR=2.04,P<0.001),3-year(OR=2.09,P=0.001),and 5-year(OR=2.06,P=0.003)overall survival rates,and there were no significant differences in the rates of lung metastasis and peritoneal metastasis between the two groups(P>0.05).Conclusions AF-PD is better than S-PD in some short-term and long-term outcome indicators such as R0 resection rate,pancreatic leakage rate,overall survival rate,and so on.However,due to the limited quality of the included literatures,more high-quality studies are still needed to verify in the future.