切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 313 -320. doi: 10.3877/cma.j.issn.1674-0793.2021.04.017

循证医学

微创胰十二指肠切除术治疗胰腺导管腺癌围手术期和近远期疗效的Meta分析
丁相元1, 任效瑛1, 闫慧明1,†()   
  1. 1. 030000　太原，山西医科大学第二医院普外科
  • 收稿日期:2020-09-27 出版日期:2021-08-03
  • 通信作者: 闫慧明

Perioperative, short-term and long-term outcomes of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A Meta-analysis

Xiangyuan Ding1, Xiaoying Ren1, Huiming Yan1,†()   

  1. 1. Department of General Surgery, the Second Hospital of Shanxi Medical University, Taiyuan 030000, China
  • Received:2020-09-27 Published:2021-08-03
  • Corresponding author: Huiming Yan
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

丁相元, 任效瑛, 闫慧明. 微创胰十二指肠切除术治疗胰腺导管腺癌围手术期和近远期疗效的Meta分析[J]. 中华普通外科学文献(电子版), 2021, 15(04): 313-320.

Xiangyuan Ding, Xiaoying Ren, Huiming Yan. Perioperative, short-term and long-term outcomes of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(04): 313-320.

目的

通过Meta分析系统评价微创胰十二指肠切除术（MIPD，腹腔镜胰十二指肠切除术和机器人胰十二指肠切除术）治疗胰腺导管腺癌的围手术期、近期及远期疗效。

方法

检索Web of Science、Pubmed、Embase、中国知网、维普、万方以及中国生物医学文献数据库，截取时间为建库至2020年9月5日，收集关于MIPD和开放胰十二指肠切除术（OPD）治疗胰腺导管腺癌的相关研究，提取数据并进行Meta分析。

结果

最终纳入11项研究11 909例患者，均为回顾性研究，其中1 555例接受了MIPD，10 354例接受了OPD。MIPD组与OPD组在术中输血百分比（OR=0.47，95% CI：0.33~0.68），住院时间（MD= -3.24，95% CI：-5.28~ -1.21），术后总体并发症（OR=0.66，95% CI：0.51~0.86），R0清除率（OR=1.22，95% CI：1.06~1.39），淋巴结切除数（MD=1.19，95% CI：0.05~2.32，P=0.04），3年总体生存率（OR=1.42，95% CI：1.10~1.84），5年总体生存率（OR=2.11，95% CI：1.35~3.31）比较，差异均有统计学意义（P<0.05）。

结论

MIPD治疗胰腺导管腺癌安全性可行。与OPD相比较，MIPD在围手术期相关观察指标、近期及远期肿瘤预后疗效具有更好的效果。

关键词: 微创手术, 胰腺导管腺癌, 胰十二指肠切除术, Meta分析
Objective

To evaluate the perioperative, short-term and long-term outcomes of minimally invasive pancreatoduodenectomy (MIPD, laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy) for pancreatic ductal adenocarcinoma by meta-analysis.

Methods

Web of science, PubMed, EMBASE, CNKI, VIP, Wanfang data and Chinese biomedical literature databases were searched from the establishment of the database to September 5, 2020. The related research on MIPD and open pancreaticoduodenectomy (OPD) in the treatment of pancreatic ductal adenocarcinoma was collected, and the data were extracted and analyzed by Meta-analysis.

Results

11 909 patients were included in 11 studies, 1 555 patients received MIPD and 10 354 patients received OPD. There were significant differences in the percentage of intraoperative blood transfusion (OR=0.47, 95% CI: 0.33-0.68), length of hospital stay (MD= -3.24, 95% CI: -5.28-1.21), overall postoperative complications (OR=0.66, 95% CI: 0.51-0.86), R0 clearance rate (OR=1.22, 95% CI: 1.06-1.39), the number of lymph nodes removed (MD=1.19, 95% CI: 0.05-2.32, P=0.04), 3-year overall survival rate (OR=1.42, 95% CI: 1.10-1.84), and 5-year overall survival rate (OR=2.11, 95% CI: 1.35-3.31) (P<0.05).

Conclusions

MIPD is safe and feasible in the treatment of pancreatic ductal adenocarcinoma. Compared with OPD, MIPD shows better effect in perioperative related observation indicators, short-term and long-term tumor prognosis.

Key words: Minimally invasive surgery, Pancreatic ductal adenocarcinoma, Pancreaticoduodenectomy, Meta analysis
表1 纳入研究基线资料的比较
基础信息 文献篇数 异质性 效应模型 Meta分析
I2(%) P值 OR/MD (95% CI) P值
年龄 6 55 0.06 随机效应模型 0.57 (-0.28,1.43) 0.19
性别 5 0 0.42 固定效应模型 1.22 (0.97,1.54) 0.10
体质指数 4 0 0.99 固定效应模型 0.12 (-0.37,0.61) 0.64
肿瘤大小 7 97 <0.001 随机效应模型 -0.12 (-0.55,0.31) 0.58
表2 纳入研究的基本特征及质量评价
第一作者及发表年 国家 研究类型 样本量(例) 中转开腹率[例(%)] 随访时间(月) NOS评分
MIPD OPD MIPD OPD
Chapman 2018[7] 美国 回顾性研究 248 1520 74(29.8) 17.1 14 8
Chen 2015[8] 中国 回顾性研究 19 38 1(5.3) 22±10 21±8 7
Croome 2014[9] 美国 回顾性研究 108 214 7(6.5) 16.5 15.1 8
Delitto 2016[10] 美国 回顾性研究 28 22 - - - 7
Dokmak 2015[11] 法国 回顾性研究 11 261 - - - 6
Kantor 2017[12] 美国 回顾性研究 828 7385 - 18 - 8
Kuesters 2018[13] 德国 回顾性研究 62 278 - - - 7
Kwon 2020[14] 韩国 回顾性研究 73 219 - - - 7
Song 2015[15] 韩国 回顾性研究 15 14 - - - 6
Staufer 2017[16] 美国 回顾性研究 58 193 14(24.1) 19.6±17.4 24.5±27.4 8
Weng 2020[17] 中国 回顾性研究 105 210 2(1.8) - - 7
图1 文献筛选过程图
表3 MIPD组与OPD组围手术期相关结局的比较
指标 文献篇数 样本量(例) 异质性 效应模型 Meta分析
MIPD OPD I2(%) P值 OR/MD(95% CI) P值
手术时间 4 33 895 98 <0.001 随机效应模型 40.17 (-17.75, 99.28) 0.170
术中失血量 4 317 663 91 <0.001 随机效应模型 -110.79 (-266.20, 44.61) 0.160
住院时间 7 1 424 9 814 80 <0.001 随机效应模型 -3.24 (-5.28, -1.21) 0.002
术后总体并发症 5 316 918 23 0.26 固定效应模型 0.66 (0.51, 0.86) 0.002
30 d死亡率 7 1 377 9 882 0 0.65 固定效应模型 1.00 (0.71,1.42) 0.980
术中输血 3 228 685 0 0.80 固定效应模型 0.47 (0.33, 0.68) <0.001
术后胰瘘 5 359 850 0 0.99 固定效应模型 0.87 (0.54, 1.39) 0.550
延迟胃排空 5 359 850 65 0.02 随机效应模型 1.36 (0.51, 3.66) 0.540
术后出血 5 359 850 0 0.57 固定效应模型 1.27 (0.69, 2.35) 0.440
图2 两组患者R0清除率比较的森林图
图3 两组患者静脉切除率比较的森林图
图4 两组患者淋巴结切除数比较的森林图
图5 两组患者术后开始化疗时段比较的森林图
图6 两组患者1年总体生存率比较的森林图
图7 两组患者3年总体生存率比较的森林图
图8 两组患者5年总体生存率比较的森林图
图9 术后总体并发症漏斗图
图10 R0清除率漏斗图
图11 3年总体生存率漏斗图
[1]
Ilic M, Ilic I. Epidemiology of pancreatic cancer[J]. World J Gastroenterol, 2016, 22(44): 9694-9705.
[2]
Rahib L, Smith BD, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States[J]. Cancer Res, 2014, 74(11): 2913-2921.
[3]
Hilst JV, Rooij TD, Hilal MA, et al. Worldwide survey on opinions and use of minimally invasive pancreatic resection[J]. HPB (Oxford), 2017, 19(3): 190-204.
[4]
Chopinet S, Fuks D, Rinaudo M, et al. Postoperative bleeding after laparoscopic pancreaticoduodenectomy: the Achilles’ heel?[J]. World J Surg, 2018, 42(4): 1138-1146.
[5]
Chen K, Liu X, Pan Y, et al. Expanding laparoscopic pancreaticoduodenectomy to pancreatic-head and periampullary malignancy: major findings based on systematic review and Meta-analysis[J]. BMC Gastroenterol, 2018, 18(1): 102.
[6]
Chen K, Pan Y, Zhang B, et al. Laparoscopic versus open pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and Meta-analysis[J]. Int J Surg, 2018, 53: 243-256.
[7]
Chapman BC, Gajdos C, Hosokawa P, et al. Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma[J]. Surg Endosc, 2018, 32(5): 2239-2248.
[8]
Chen S, Chen JZ, Zhan Q, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: A prospective, matched, mid-term follow-up study[J]. Surg Endosc, 2015, 29(12): 3698-3711.
[9]
Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?[J]. Ann Surg, 2014, 260(4): 633-638.
[10]
Delitto D, Luckhurst CM, Black BS, et al. Oncologic and perioperative outcomes following selective application of laparoscopic pancreaticoduodenectomy for periampullary malignancies[J]. J Gastrointest Surg, 2016, 20(7): 1343-1349.
[11]
Dokmak S, Ftériche FS, Aussilhou B, et al. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors[J]. J Am Coll Surg, 2015, 220(5): 831-838.
[12]
Kantor O, Talamonti MS, Sharpe S, et al. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy[J]. Am J Surg, 2017, 213(3): 512-515.
[13]
Kuesters S, Chikhladze S, Makowiec F, et al. Oncological outcome of laparoscopically assisted pancreatoduodenectomy for ductal adenocarcinoma in a retrospective cohort study[J]. Int J Surg, 2018, 55: 162-166.
[14]
Kwon J, Song KB, Park SY, et al. Comparison of minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: A propensity score matching analysis[J]. Cancers, 2020, 12(4): 982.
[15]
Song KB, Kim SC, Hwang DW, et al. Matched case-control analysis comparing laparoscopic and open pylorus-preserving pancreaticoduodenectomy in patients with periampullary tumors[J]. Ann Surg, 2015, 262(1): 146-155.
[16]
Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution[J]. Surg Endosc, 2017, 31(5): 2233-2241.
[17]
Weng Y, Jiang Y, Fu N, et al. Oncological outcomes of robotic-assisted versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: A propensity score-matched analysis[J]. Surg Endosc, 2020, 35(7): 3437-3448.
[18]
Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy[J]. Surg Endosc, 1994, 8(5): 408-410.
[19]
Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital[J]. Arch Surg, 2003, 138(7): 777-784.
[20]
Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: A single institution’s experience in open, laparoscopic, and robotic approaches[J]. J Am Coll Surg, 2015, 220(1): 18-27.
[21]
Soh YF, Kow AW, Wong KY, et al. Perioperative outcomes of laparoscopic and open distal pancreatectomy: our institution’s 5-year experience[J]. Asian J Surg, 2012, 35(1): 29-36.
[22]
Eom BW, Jang JY, Lee SE, et al. Clinical outcomes compared between laparoscopic and open distal pancreatectomy[J]. Surg Endosc, 2008, 22(5): 1334-1338.
[23]
Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: A retrospective multicenter analysis of 1 029 patients[J]. Ann Surg, 2021, 273(1): 145-153.
[24]
Kneuertz PJ, Patel SH, Chu CK, et al. Effects of perioperative red blood cell transfusion on disease recurrence and survival after pancreaticoduodenectomy for ductal adenocarcinoma[J]. Ann Surg Oncol, 2011, 18(5): 1327-1334.
[25]
Wu WC, Smith TS, Henderson WG, et al. Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery[J]. Ann Surg, 2010, 252(1): 11-17.
[26]
Mirkin KA, Greenleaf EK, Hollenbeak CS, et al. Minimally invasive surgical approaches offer earlier time to adjuvant chemotherapy but not improved survival in resected pancreatic cancer[J]. Surg Endosc, 2018, 32(5): 2387-2396.
[27]
Zhang H, Wu XH, Zhu F, et al. Systematic review and meta-analysis of minimally invasive versus open approach for pancreaticoduodenectomy[J]. Surg Endosc, 2016, 30(12): 5173-5184.
[1] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[2] 罗旺林, 杨传军, 许国星, 俞建国, 孙伟东, 颜文娟, 冯志. 开放性楔形胫骨高位截骨术不同植入材料的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 818-826.
[3] 马鹏程, 刘伟, 张思平. 股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 653-662.
[4] 陈宏兴, 张立军, 张勇, 李虎, 周驰, 凡一诺. 膝骨关节炎关节镜清理术后中药外用疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(05): 663-672.
[5] 邢阳, 何爱珊, 康焱, 杨子波, 孟繁钢, 邬培慧. 前交叉韧带单束联合前外侧结构重建的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 508-519.
[6] 李雄雄, 周灿, 徐婷, 任予, 尚进. 初诊导管原位癌伴微浸润腋窝淋巴结转移率的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 466-474.
[7] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[8] 武慧铭, 郭仁凯, 李辉宇. 机器人辅助下经自然腔道取标本手术治疗结直肠癌安全性和有效性的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(05): 395-400.
[9] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[10] 李炳根, 龚独辉, 赖泽如, 聂向阳. 产后腹直肌分离全腔镜下肌后/腹膜外补片修补术的临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 724-727.
[11] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[12] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[13] 杨海龙, 邓满军, 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元. 腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 545-550.
[14] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
[15] 谭可, 李锦平, 彭玉涛, 吴文汧, 杨子文, 汪阳, 陶立波, 刘畅. 机器人辅助立体定向血肿引流术治疗自发性脑出血疗效及卫生经济学评价[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 205-214.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号