Superior mesenteric artery first approach can improve the clinical outcomes of pancreaticoduodenectomy: A meta-analysis
Superior mesenteric artery (SMA) first approach was a new improvement for pancreaticoduodenectomy (PD), but there is no evidence whether this approach is advantageous to PD. This meta-analysis aimed to determine the effects of the superior mesenteric artery (SMA) first approach on outcomes of pancre...
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| Veröffentlicht in: | International journal of surgery (London, England) England), 2020-01, Vol.73, p.14-24 |
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| container_title | International journal of surgery (London, England) |
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| creator | Jiang, Xiangyan Yu, Zeyuan Ma, Zhijian Deng, Haixiao Ren, Wen Shi, Wengui Jiao, Zuoyi |
| description | Superior mesenteric artery (SMA) first approach was a new improvement for pancreaticoduodenectomy (PD), but there is no evidence whether this approach is advantageous to PD. This meta-analysis aimed to determine the effects of the superior mesenteric artery (SMA) first approach on outcomes of pancreaticoduodenectomy (PD).
Literature searches were conducted on PubMed, The Cochrane Library, EMBASE, Web of Science, Clinical Trials Registry and China Biology Medicine disc. We completed a meta-analysis of the SMA first approach in PD, assessing overall survival, R0 resection, blood loss, postoperative complications, operation time and postoperative stay. The odds ratios and weighted mean differences with 95% confidence intervals (CIs) were pooled.
Eighteen studies comprising 1483 participants were included. Patients who received SMA-PD had significantly lower overall complication rate (OR 0.62, 95% CI 0.47 to 0.81, P = 0.001) and less blood loss (WMD -264.84, 95% CI -336.1 to −193.58, P |
| doi_str_mv | 10.1016/j.ijsu.2019.11.007 |
| format | Article |
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Literature searches were conducted on PubMed, The Cochrane Library, EMBASE, Web of Science, Clinical Trials Registry and China Biology Medicine disc. We completed a meta-analysis of the SMA first approach in PD, assessing overall survival, R0 resection, blood loss, postoperative complications, operation time and postoperative stay. The odds ratios and weighted mean differences with 95% confidence intervals (CIs) were pooled.
Eighteen studies comprising 1483 participants were included. Patients who received SMA-PD had significantly lower overall complication rate (OR 0.62, 95% CI 0.47 to 0.81, P = 0.001) and less blood loss (WMD -264.84, 95% CI -336.1 to −193.58, P < 0.001). The obviously increased R0 resection rate (OR 2.92, 95% CI 1.72 to 4.96, P < 0.001) and 3-year OS (OR 2.15, 95% CI 1.34 to 3.43, P = 0.001) were found in the SMA-PD group.
The SMA-PD group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients; furthermore, the patients acquired superior clinical efficacy via the posterior approach in SMA-PD.
•Operative efficacy was different between six SMA approaches, and the posterior approach exerted the optimal clinical outcomes.•The SMA approach appears remarkable advantages for achievement of R0 resection and reduction of blood loss.•The SMA group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients.</description><identifier>ISSN: 1743-9191</identifier><identifier>EISSN: 1743-9159</identifier><identifier>DOI: 10.1016/j.ijsu.2019.11.007</identifier><identifier>PMID: 31751791</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Mesenteric Artery, Superior - surgery ; Middle Aged ; Pancreatic cancer ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Postoperative Complications - etiology ; R0 resection ; Superior mesenteric artery ; Treatment Outcome</subject><ispartof>International journal of surgery (London, England), 2020-01, Vol.73, p.14-24</ispartof><rights>2019 IJS Publishing Group Ltd</rights><rights>Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-96476677ea70e6698a54d154838f3df8507f13705afb8a30362c6fa916423a2e3</citedby><cites>FETCH-LOGICAL-c466t-96476677ea70e6698a54d154838f3df8507f13705afb8a30362c6fa916423a2e3</cites><orcidid>0000-0001-8090-1279</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijsu.2019.11.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31751791$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jiang, Xiangyan</creatorcontrib><creatorcontrib>Yu, Zeyuan</creatorcontrib><creatorcontrib>Ma, Zhijian</creatorcontrib><creatorcontrib>Deng, Haixiao</creatorcontrib><creatorcontrib>Ren, Wen</creatorcontrib><creatorcontrib>Shi, Wengui</creatorcontrib><creatorcontrib>Jiao, Zuoyi</creatorcontrib><title>Superior mesenteric artery first approach can improve the clinical outcomes of pancreaticoduodenectomy: A meta-analysis</title><title>International journal of surgery (London, England)</title><addtitle>Int J Surg</addtitle><description>Superior mesenteric artery (SMA) first approach was a new improvement for pancreaticoduodenectomy (PD), but there is no evidence whether this approach is advantageous to PD. This meta-analysis aimed to determine the effects of the superior mesenteric artery (SMA) first approach on outcomes of pancreaticoduodenectomy (PD).
Literature searches were conducted on PubMed, The Cochrane Library, EMBASE, Web of Science, Clinical Trials Registry and China Biology Medicine disc. We completed a meta-analysis of the SMA first approach in PD, assessing overall survival, R0 resection, blood loss, postoperative complications, operation time and postoperative stay. The odds ratios and weighted mean differences with 95% confidence intervals (CIs) were pooled.
Eighteen studies comprising 1483 participants were included. Patients who received SMA-PD had significantly lower overall complication rate (OR 0.62, 95% CI 0.47 to 0.81, P = 0.001) and less blood loss (WMD -264.84, 95% CI -336.1 to −193.58, P < 0.001). The obviously increased R0 resection rate (OR 2.92, 95% CI 1.72 to 4.96, P < 0.001) and 3-year OS (OR 2.15, 95% CI 1.34 to 3.43, P = 0.001) were found in the SMA-PD group.
The SMA-PD group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients; furthermore, the patients acquired superior clinical efficacy via the posterior approach in SMA-PD.
•Operative efficacy was different between six SMA approaches, and the posterior approach exerted the optimal clinical outcomes.•The SMA approach appears remarkable advantages for achievement of R0 resection and reduction of blood loss.•The SMA group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Mesenteric Artery, Superior - surgery</subject><subject>Middle Aged</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Postoperative Complications - etiology</subject><subject>R0 resection</subject><subject>Superior mesenteric artery</subject><subject>Treatment Outcome</subject><issn>1743-9191</issn><issn>1743-9159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1u1TAQha2Kqn_wAiyQl2wSPHFiJ4hNVUFBqsSisLamzlj1VRIH22l13x5f3dIlq5mRzjkz8zH2HkQNAtSnXe13aasbAUMNUAuhT9gF6FZWA3TDm9d-gHN2mdJOiFb00J-xcwm6Az3ABXu-31aKPkQ-U6Ill95yjKXuufMxZY7rGgPaR25x4X4uwxPx_EjcTn7xFicetmxDsfPg-IqLjYTZ2zBuYaSFbA7z_jO_LgsyVrjgtE8-vWWnDqdE717qFfv97euvm-_V3c_bHzfXd5VtlcrVoFqtlNaEWpBSQ49dO0LX9rJ3cnR9J7QDqUWH7qFHKaRqrHI4gGobiQ3JK_bxmFvu_rNRymb2ydI04UJhS6Y5oOgV9LJIm6PUxpBSJGfW6GeMewPCHICbnTkANwfgBsAU4MX04SV_e5hpfLX8I1wEX44CKl8-eYomWU-LpdHHwsaMwf8v_y87HZOV</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Jiang, Xiangyan</creator><creator>Yu, Zeyuan</creator><creator>Ma, Zhijian</creator><creator>Deng, Haixiao</creator><creator>Ren, Wen</creator><creator>Shi, Wengui</creator><creator>Jiao, Zuoyi</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8090-1279</orcidid></search><sort><creationdate>202001</creationdate><title>Superior mesenteric artery first approach can improve the clinical outcomes of pancreaticoduodenectomy: A meta-analysis</title><author>Jiang, Xiangyan ; Yu, Zeyuan ; Ma, Zhijian ; Deng, Haixiao ; Ren, Wen ; Shi, Wengui ; Jiao, Zuoyi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-96476677ea70e6698a54d154838f3df8507f13705afb8a30362c6fa916423a2e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Mesenteric Artery, Superior - surgery</topic><topic>Middle Aged</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Postoperative Complications - etiology</topic><topic>R0 resection</topic><topic>Superior mesenteric artery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jiang, Xiangyan</creatorcontrib><creatorcontrib>Yu, Zeyuan</creatorcontrib><creatorcontrib>Ma, Zhijian</creatorcontrib><creatorcontrib>Deng, Haixiao</creatorcontrib><creatorcontrib>Ren, Wen</creatorcontrib><creatorcontrib>Shi, Wengui</creatorcontrib><creatorcontrib>Jiao, Zuoyi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of surgery (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jiang, Xiangyan</au><au>Yu, Zeyuan</au><au>Ma, Zhijian</au><au>Deng, Haixiao</au><au>Ren, Wen</au><au>Shi, Wengui</au><au>Jiao, Zuoyi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Superior mesenteric artery first approach can improve the clinical outcomes of pancreaticoduodenectomy: A meta-analysis</atitle><jtitle>International journal of surgery (London, England)</jtitle><addtitle>Int J Surg</addtitle><date>2020-01</date><risdate>2020</risdate><volume>73</volume><spage>14</spage><epage>24</epage><pages>14-24</pages><issn>1743-9191</issn><eissn>1743-9159</eissn><abstract>Superior mesenteric artery (SMA) first approach was a new improvement for pancreaticoduodenectomy (PD), but there is no evidence whether this approach is advantageous to PD. This meta-analysis aimed to determine the effects of the superior mesenteric artery (SMA) first approach on outcomes of pancreaticoduodenectomy (PD).
Literature searches were conducted on PubMed, The Cochrane Library, EMBASE, Web of Science, Clinical Trials Registry and China Biology Medicine disc. We completed a meta-analysis of the SMA first approach in PD, assessing overall survival, R0 resection, blood loss, postoperative complications, operation time and postoperative stay. The odds ratios and weighted mean differences with 95% confidence intervals (CIs) were pooled.
Eighteen studies comprising 1483 participants were included. Patients who received SMA-PD had significantly lower overall complication rate (OR 0.62, 95% CI 0.47 to 0.81, P = 0.001) and less blood loss (WMD -264.84, 95% CI -336.1 to −193.58, P < 0.001). The obviously increased R0 resection rate (OR 2.92, 95% CI 1.72 to 4.96, P < 0.001) and 3-year OS (OR 2.15, 95% CI 1.34 to 3.43, P = 0.001) were found in the SMA-PD group.
The SMA-PD group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients; furthermore, the patients acquired superior clinical efficacy via the posterior approach in SMA-PD.
•Operative efficacy was different between six SMA approaches, and the posterior approach exerted the optimal clinical outcomes.•The SMA approach appears remarkable advantages for achievement of R0 resection and reduction of blood loss.•The SMA group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>31751791</pmid><doi>10.1016/j.ijsu.2019.11.007</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-8090-1279</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Female Humans Male Mesenteric Artery, Superior - surgery Middle Aged Pancreatic cancer Pancreatic Neoplasms - surgery Pancreaticoduodenectomy Pancreaticoduodenectomy - adverse effects Pancreaticoduodenectomy - methods Postoperative Complications - etiology R0 resection Superior mesenteric artery Treatment Outcome |
| title | Superior mesenteric artery first approach can improve the clinical outcomes of pancreaticoduodenectomy: A meta-analysis |
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