海德堡三角清扫胰十二指肠切除术与标准胰十二指肠切除术治疗胰腺癌疗效比较的Meta分析

Meta-analysis comparing the efficacy of pancreaticoduodenectomy with Heidelberg triangle operation and standard pancreaticoduodenectomy in the treatment of pancreatic cancer

背景与目的:海德堡三角清扫胰十二指肠切除术(PD_(TRIANGLE))与标准胰十二指肠切除术(PD_(STANDARD))哪种治疗方式更有利于胰腺癌患者,目前尚无一致结论,亦无大样本的多中心研究予以证实。因此,本研究通过Meta分析比较PD_(TRIANGLE)与PD_(STANDARD)治疗胰腺癌的临床疗效及安全性。方法:检索中英文网络数据库,根据纳入标准筛选对比两种手术方式治疗胰腺癌的相关文献。检索时间从建库到2024年5月,使用Review Manager 5.3软件对提取的相关结局指标进行Meta分析。结果:最终纳入6篇回顾性研究,共计658例患者,其中PD_(TRIANGLE)组315例,PD_(STANDARD)组343例。Meta分析结果显示,PD_(TRIANGLE)组手术时间长于PD_(STANDARD)组(OR=1.52,95%CI=0.42~2.61,P=0.007)、淋巴结清扫率高于PD_(STANDARD)组(OR=0.70,95%CI=0.4~1.01,P<0.00001)、R0切除率高于PD_(STANDARD)组(OR=1.63,95%CI=1.03~2.58,P=0.04);PD_(TRIANGLE)组术后淋巴瘘与腹泻发生率高于PD_(STANDARD)组(OR=5.60,95%CI=1.81~17.29,P=0.003;OR=0.13,95%CI=0.07~0.20,P<0.0001);PD_(TRIANGLE)组住院时间长于PD_(STANDARD)组(OR=0.40;95%CI=0.14~0.65,P=0.003);PD_(TRIANGLE)组1、2年总体生存率明显优于PD_(STANDARD)组(OR=2.19,95%CI=1.27~3.76,P=0.005;OR=1.65,95%CI=1.01~2.67,P=0.04)、1年无瘤生存率明显优于PD_(STANDARD)组(OR=3.71,95%CI=2.27~6.07,P<0.00001),但两组的2年无瘤生存率差异无统计学意义(OR=2.63,95%CI=0.91~7.59,P=0.07)。结论:PD_(TRIANGLE)治疗胰腺癌安全、有效。与PD_(STANDARD)相比,PD_(TRIANGLE)可显著提高R0切除率,从而改善患者术后无瘤生存率,获得较好的远期预后。

Background and Aims:There is currently no consensus on whether the pancreaticoduodenectomy with Heidelberg triangle operation(PD_(TRIANGLE))or the standard radical pancreaticoduodenectomy(PD_(STANDARD))is more beneficial for patients with pancreatic cancer,and no large-scale multicenter studies have confirmed this.Therefore,this study was conducted to compare the clinical efficacy and safety of PD_(TRIANGLE) and PD_(STANDARD) for treating pancreatic cancer through a Meta-analysis.Methods:Relevant literature comparing the two surgical approaches comparing the two surgical approaches for treating pancreatic cancer was screened from Chinese and English databases based on inclusion criteria.The search timeframe extended from the inception of the databases to May 2024,and Review Manager 5.3 software was used for Meta-analysis of the extracted outcome variables.Results:A total of 6 retrospective studies were included,comprising 658 patients,with 315 in the PD_(TRIANGLE) group and 343 in the PD_(STANDARD) group.The Meta-analysis results showed that the operative time in the PD_(TRIANGLE) group was longer than that in the PD_(STANDARD) group(OR=1.52,95%CI=0.42-2.61,P=0.007),the lymph node dissection rate was higher in the PD_(TRIANGLE) group(OR=0.70,95%CI=0.4-1.01,P<0.00001),and the R0 resection rate was also higher in the PD_(TRIANGLE) group(OR=1.63,95%CI=1.03-2.58,P=0.04).The incidence rates of postoperative lymphatic fistula and diarrhea were higher in the PD_(TRIANGLE) group compared to the PD_(STANDARD) group(OR=5.60,95%CI=1.81-17.29,P=0.003;OR=0.13,95%CI=0.07-0.20,P<0.0001).The length of hospital stay was longer in the PD_(TRIANGLE) group(OR=0.40;95%CI=0.14-0.65,P=0.003).The overall survival rates at 1 and 2 years were significantly better in the PD_(TRIANGLE) group compared to the PD_(STANDARD) group(OR=2.19,95%CI=1.27-3.76,P=0.005;OR=1.65,95%CI=1.01-2.67,P=0.04),and the 1-year disease-free survival rate was also significantly higher in the PD_(TRIANGLE) group(OR=3.71,95%CI=2.27-6.07,P<0.00001),although the difference in the 2-year disease-free survival rate between the two groups was not statistically significant(OR=2.63,95%CI=0.91-7.59,P=0.07).Conclusion:PD_(TRIANGLE) is a safe and effective treatment for pancreatic cancer.Compared to PD_(STANDARD),PD_(TRIANGLE) significantly improves the R0 resection rate,thereby enhancing the postoperative disease-free survival rate and achieving a better long-term prognosis.