Open AccessThe impact of venous resection in pancreatoduodectomy
Author(s) -
João Emílio Lemos Pinheiro Filho,
Francisco Tustumi,
Fabrício Ferreira Coelho,
Sérgio Silveira Júnior,
Fernanda Cavalcanti Cabral Honório,
Alexandre Cruz Henriques,
André Roncon Dias,
Jaques Waisberg
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000027438
Subject(s) - medicine , hazard ratio , confidence interval , surgery , risk assessment , pancreatic cancer , resection , cancer , computer security , computer science
Background: Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial. Objective: This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD). Methods: A systematic review and meta-analysis of studies comparing VRPD and PD were performed. Results: VRPD was associated with a higher risk for postoperative mortality (risk difference: −0.01; 95% confidence interval [CI] −0.02 to −0.00) and complications (risk difference: −0.05; 95% CI −0.09 to −0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: −0.65; 95% CI −2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: −69.09; 95% CI −88.4 to −49.78), with a higher blood loss rate (MD: −314.04; 95% CI −423.86 to −195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03–1.23). Conclusion: VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.