Short-Term Outcomes of Arterial Divestment in Pancreatic Cancer: A Systematic Review and Single Arm Meta-Analysis of Observational Studies.

Abstract

The present study aimed to review and analyze the impact of arterial divestment during pancreatic surgery on short-term outcomes. PubMed, Embase, Web of Science, and the Cochrane Library were searched. Outcomes of interest included perioperative parameters, resection margins, morbidity, and mortality. Analysis was performed using the meta package in R. Five observational studies comprising 554 patients were included. Two hundred twelve patients had upfront surgery, and 342 patients had neoadjuvant chemotherapy. Four hundred and eighty-two had periarterial dissection and 72 sub adventitial dissection. Operative time varied considerably (median 185-537 min), and intraoperative blood loss ranged between 300 and 900 mL. The pooled prevalence of blood transfusion was 37.6% (95% CI: 32.5%-43.1%; I² = 97.7%). Median post-operative stay ranged from 7 to 25 days. R0 resection was achieved in 49.4% (95% CI: 44.9%-53.8%). Complications included post-operative pancreatic fistula (9.2%), delayed gastric emptying (11.2%), post-operative pancreatic hemorrhage (5.8%), chyle leakage (13.9%), reoperation (6.1%), 90-day mortality (3.1%), bile leakage (≤ 2.8%), ischemia (≤ 4.2%), and intractable diarrhea (8%-13%). Arterial divestment during pancreatic surgery appears to have acceptable morbidity and mortality. However, there is a lack of a unified agreed definition and case selection. A unified reporting, standardization of terminology and relative role compared to arterial resection should be explored in prospective studies.