Systematic Review and Meta-analysis of the Role of Total Pancreatectomy as an Alternative to Pancreatoduodenectomy in Patients at High Risk for Postoperative Pancreatic Fistula

Author:

Stoop Thomas F.1234,Bergquist Erik1,Theijse Rutger T.23,Hempel Sebastian5ORCID,van Dieren Susan2,Sparrelid Ernesto1ORCID,Distler Marius5,Hackert Thilo6,Besselink Marc G.23ORCID,Del Chiaro Marco4,Ghorbani Poya1,

Affiliation:

1. Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden

2. Amsterdam UMC, location University of Amsterdam, Department of Surgery

3. Cancer Center Amsterdam, Amsterdam, The Netherlands

4. Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO

5. Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

6. Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany

Abstract

Objective: Examine the potential benefit of total pancreatectomy (TP) as an alternative to pancreatoduodenectomy (PD) in patients at high risk for postoperative pancreatic fistula (POPF). Summary Background Data: TP is mentioned as an alternative to PD in patients at high risk for POPF, but a systematic review is lacking. Methods: Systematic review and meta-analyses using Pubmed, Embase (Ovid), and Cochrane Library to identify studies published up to October 2022, comparing elective single-stage TP for any indication versus PD in patients at high risk for POPF. The primary endpoint was short-term mortality. Secondary endpoints were major morbidity (i.e., Clavien-Dindo grade ≥IIIa) on the short-term and quality of life. Results: After screening 1212 unique records, five studies with 707 patients (334 TP and 373 high-risk PD) met the eligibility criteria, comprising one randomized controlled trial and four observational studies. The 90-day mortality after TP and PD did not differ (6.3% vs. 6.2%; RR=1.04 [95%CI 0.56-1.93]). Major morbidity rate was lower after TP compared to PD (26.7% vs. 38.3%; RR=0.65 [95%CI 0.48-0.89]), but no significance was seen in matched/randomized studies (29.0% vs. 36.9%; RR = 0.73 [95%CI 0.48-1.10]). Two studies investigated quality of life (EORTC QLQ-C30) at a median of 30-52 months, demonstrating comparable global health status after TP and PD (77% [±15] vs. 76% [±20]; P=0.857). Conclusions: This systematic review and meta-analysis found no reduction in short-term mortality and major morbidity after TP as compared to PD in patients at high risk for POPF. However, if TP is used as a bail-out procedure, the comparable long-term quality of life is reassuring.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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