Meta-analysis Of The Efficacy Of Different Surgical Methods For Insulinoma

Objective:Most insulinomas are benign single tumors that can be cured by surgery,but there is a lack of comparative analysis of the clinical efficacy of surgical treatment of insulinomas at home and abroad.Therefore,in this study,we performed a meta-analysis of the efficacy of different surgical methods in the treatment of insulin to provide ideas for the surgical treatment of insulin.Methods:We searched relevant literature about surgical treatment of insulinoma in data databases,such as China National Knowledge Infrastructure,Wanfang,VIP,Chinese Biomedical Literature Full-text Database(CBM),web of science Readshow,Pub Med,Embace,and Cochrance Library,.It retrieved literatures were screened according to the established conditions.Relevant literatures that met the criteria were extracted.Review Manager 5.3 was used for meta-analysis,and the statistical data were analyzed and discussed.Results:A total of 25 retrospective studies with 1446 patients were included.Meta-analysis showed that there was a significant difference in the operation time between insulinoma resection and pancreatectomy(MD =-56.57,95% CI:-67.48 –-45.65,P = 0.00001);there was a significant difference in the intraoperative blood loss between insulinoma resection and pancreatectomy(MD =-152.01,95%-188.49,-115.53,P = 0.00001);there was no significant difference in the length of hospital stay after insulinoma resection and pancreatectomy(MD =-0.22,95% CI:-2.21 – 1.76,.P = 0.83);there was no significant difference in postoperative pancreatic leakage between insulin extraction and pancreatectomy(OR = 1.29,95% CI: 0.96 – 1.76,P = 0.10);there was no significant difference in operation time between laparoscopic insulinoma extraction and open insulinoma extraction(MD =-4.23,95% CI:-44.27 – 35.81,P = 0.84);there was a significant difference in intraoperative bleeding between laparoscopic surgery and open surgery(MD =-32.39,95% CI:-60.07 – 1.72,P = 0.12);there was no significant difference in operation time between laparoscopic insulinoma extraction and open insulinoma extraction(MD =-32.36,95% CI:-71.13 – 12.41);there was a significant difference in hospital stay between laparoscopic insulinoma surgery and open insulinoma surgery(MD =-4.42,95% CI:-5.69 –-2.75,P < 0.00001).Among 15 literatures,laparoscopic insulinoma was converted into laparotomy,and among 395 cases of laparoscopic surgery,73 cases were converted into laparotomy.Difficult intraoperative localization was the main reason for conversion to laparotomy,accounting for about 53%of the total;close to blood vessels or pancreatic duct,about 26%;bleeding,7%;abdominal adhesions,11%;multiple insulinomas,3%.Conclusion:Compared with pancreatectomy,insulinoma resection has shorter operation time,less intraoperative blood loss and does not increase the incidence of pancreatic leakage.It is a safe and effective surgical method.Although laparoscopic insulinoma does not shorten the operation time and reduce bleeding,it has the advantages of less trauma and shorter postoperative recovery time,which is worthy of promotion in the treatment of insulinoma.。...