PDF(Pubmed)
Abstract：
BACKGROUND: Pancreatoduodenectomy (PD) has a considerable surgical risk for complications and late metabolic morbidity. Parenchyma-sparing resection of benign tumors has the potential to cure patients associated with reduced procedure-related short- and long-term complications.
METHODS: Pubmed, Embase, and Cochrane libraries were searched for studies reporting surgery-related complications following PD and duodenum-preserving total (DPPHRt) or partial (DPPHRp) pancreatic head resection for benign tumors. A total of 38 cohort studies that included data from 1262 patients were analyzed. In total, 729 patients underwent DPPHR and 533 PD.
RESULTS: Concordance between preoperative diagnosis of benign tumors and final histopathology was 90.57% for DPPHR. Cystic and neuroendocrine neoplasms (PNETs) and periampullary tumors (PATs) were observed in 497, 89, and 31 patients, respectively. In total, 34 of 161 (21.1%) patients with intraepithelial papillar mucinous neoplasm exhibited severe dysplasia in the final histopathology. The meta-analysis, when comparing DPPHRt and PD, revealed in-hospital mortality of 1/362 (0.26%) and 8/547 (1.46%) patients, respectively [OR 0.48 (95% CI 0.15-1.58); p = 0.21], and frequency of reoperation of 3.26 % and 6.75%, respectively [OR 0.52 (95% CI 0.28-0.96); p = 0.04]. After a follow-up of 45.8 ± 26.6 months, 14/340 patients with intraductal papillary mucinous neoplasms/mucinous cystic neoplasms (IPMN/MCN, 4.11%) and 2/89 patients with PNET (2.24%) exhibited tumor recurrence. Local recurrence at the resection margin and reoccurrence of tumor growth in the remnant pancreas was comparable after DPPHR or PD [OR 0.94 (95% CI 0.178-5.34); p = 0.96].
CONCLUSIONS: DPPHR for benign, premalignant neoplasms provides a cure for patients with low risk of tumor recurrence and significantly fewer early surgery-related complications compared with PD. DPPHR has the potential to replace PD for benign, premalignant cystic and neuroendocrine neoplasms.
METHODS: Pubmed, Embase, and Cochrane libraries were searched for studies reporting surgery-related complications following PD and duodenum-preserving total (DPPHRt) or partial (DPPHRp) pancreatic head resection for benign tumors. A total of 38 cohort studies that included data from 1262 patients were analyzed. In total, 729 patients underwent DPPHR and 533 PD.
RESULTS: Concordance between preoperative diagnosis of benign tumors and final histopathology was 90.57% for DPPHR. Cystic and neuroendocrine neoplasms (PNETs) and periampullary tumors (PATs) were observed in 497, 89, and 31 patients, respectively. In total, 34 of 161 (21.1%) patients with intraepithelial papillar mucinous neoplasm exhibited severe dysplasia in the final histopathology. The meta-analysis, when comparing DPPHRt and PD, revealed in-hospital mortality of 1/362 (0.26%) and 8/547 (1.46%) patients, respectively [OR 0.48 (95% CI 0.15-1.58); p = 0.21], and frequency of reoperation of 3.26 % and 6.75%, respectively [OR 0.52 (95% CI 0.28-0.96); p = 0.04]. After a follow-up of 45.8 ± 26.6 months, 14/340 patients with intraductal papillary mucinous neoplasms/mucinous cystic neoplasms (IPMN/MCN, 4.11%) and 2/89 patients with PNET (2.24%) exhibited tumor recurrence. Local recurrence at the resection margin and reoccurrence of tumor growth in the remnant pancreas was comparable after DPPHR or PD [OR 0.94 (95% CI 0.178-5.34); p = 0.96].
CONCLUSIONS: DPPHR for benign, premalignant neoplasms provides a cure for patients with low risk of tumor recurrence and significantly fewer early surgery-related complications compared with PD. DPPHR has the potential to replace PD for benign, premalignant cystic and neuroendocrine neoplasms.
摘要：
背景：胰十二指肠切除术（PD）具有相当大的并发症和晚期代谢发病率的手术风险。良性肿瘤的薄壁组织保留切除术有可能治愈与减少手术相关的短期和长期并发症相关的患者。
方法：发布，Embase,我们在Cochrane图书馆中搜索了报告PD和保留十二指肠的全部(DPPHRt)或部分(DPPHRp)胰头切除良性肿瘤后手术相关并发症的研究.总共分析了38项队列研究，包括来自1262名患者的数据。总的来说,729例患者接受DPPHR和533例PD。
结果：对于DPPHR，良性肿瘤的术前诊断与最终组织病理学的一致性为90.57％。在497、89和31例患者中观察到囊性和神经内分泌肿瘤（PNETs）和壶腹周围肿瘤（PAT）。分别。总的来说,161例上皮内乳头状黏液性肿瘤患者中有34例（21.1％）在最终的组织病理学中表现出严重的异型增生。荟萃分析，当比较DPPHRt和PD时，显示1/362（0.26％）和8/547（1.46％）患者的住院死亡率，[OR分别为0.48（95%CI0.15-1.58）；p=0.21]，再次手术频率分别为3.26%和6.75%，分别为[OR0.52（95%CI0.28-0.96）；p=0.04]。随访45.8±26.6个月，14/340例导管内乳头状粘液性肿瘤/粘液性囊性肿瘤（IPMN/MCN，4.11％）和2/89PNET（2.24％）患者出现肿瘤复发。DPPHR或PD后切除边缘的局部复发和残留胰腺中肿瘤生长的复发具有可比性[OR0.94（95％CI0.178-5.34）；p=0.96]。
结论：DPPHR用于良性，与PD相比,癌前肿瘤为肿瘤复发风险低、早期手术相关并发症显著减少的患者提供了治愈方法.DPPHR有可能取代良性PD，癌前囊性和神经内分泌肿瘤。
方法：发布，Embase,我们在Cochrane图书馆中搜索了报告PD和保留十二指肠的全部(DPPHRt)或部分(DPPHRp)胰头切除良性肿瘤后手术相关并发症的研究.总共分析了38项队列研究，包括来自1262名患者的数据。总的来说,729例患者接受DPPHR和533例PD。
结果：对于DPPHR，良性肿瘤的术前诊断与最终组织病理学的一致性为90.57％。在497、89和31例患者中观察到囊性和神经内分泌肿瘤（PNETs）和壶腹周围肿瘤（PAT）。分别。总的来说,161例上皮内乳头状黏液性肿瘤患者中有34例（21.1％）在最终的组织病理学中表现出严重的异型增生。荟萃分析，当比较DPPHRt和PD时，显示1/362（0.26％）和8/547（1.46％）患者的住院死亡率，[OR分别为0.48（95%CI0.15-1.58）；p=0.21]，再次手术频率分别为3.26%和6.75%，分别为[OR0.52（95%CI0.28-0.96）；p=0.04]。随访45.8±26.6个月，14/340例导管内乳头状粘液性肿瘤/粘液性囊性肿瘤（IPMN/MCN，4.11％）和2/89PNET（2.24％）患者出现肿瘤复发。DPPHR或PD后切除边缘的局部复发和残留胰腺中肿瘤生长的复发具有可比性[OR0.94（95％CI0.178-5.34）；p=0.96]。
结论：DPPHR用于良性，与PD相比,癌前肿瘤为肿瘤复发风险低、早期手术相关并发症显著减少的患者提供了治愈方法.DPPHR有可能取代良性PD，癌前囊性和神经内分泌肿瘤。
