Meta Analysis Of Panceatectomy Combined With PV/SMV Resection And Reconstruction For Pancreatic Cancer

Background:Pancreatic cancer remains to be one of the most malignancy tumor, the only way to cure is radical resection. Because of the anatomy characteristics and the invasiveness of the pancreatic cancer, the portal vein, superior mesenteric vein and superior mesenteric artery are often involved by the tumor of the pancreatic head and neck, which increases the perioperative morbidity and mortality, and also affects the long time survival. The vessels involvement was once thought to be contraindication for operation. As the operative technique developed, more and more research indicates that, combined with vascular resection and reconstruction, the pancreatectomy could achieve similar survival between patients whose SMV/PV were involved by the tumor and those who were not. Base on the current results, the Borderline Resectable pancreatic cancer were defined, which expands the indications for operation, and gives more patients a chance to get radical resection. But related retrospective random trial is absent. Based on this background, we apply meta-analysis technique to make an evidence-based evaluation on the perioperative outcomes and long-time survival between patients undergoes pancreatectomy combined with SMV/PV resection and those who doesn’t, which could guide our strategy.Methods:We searched the database of Medline and PubMed, and studies directly comparing pancreatectomy combined with SMV/PV resection and not focused on clinical outcomes from2000to now. After checking the title, abstract, method and results, we choose the studies that fit our requirements. We extract the original data including the first author, time of publication, research type, country and region, years of data collection, number of patients, gender, age, type of operation, time of operation, blood loss, mean tumor size, RO resection rate, lymph nodes metastasis rate, perioperative morbidity and mortality, pancreatic fistula, thrombosis after vascular resection,1-year,3-year and5-year survival, and make meta-analysis on the data with more than3studies.Results:In perioperative outcomes, patients in VR+group has significantly delayed operation time than VR-group (P<0.01), the RO resection rate is lower in VR+group (P<0.01), lymph nodes metastasis rate is higher in VR+group (P=0.01), the morbidity has no significant difference between two groups (P=0.53). The long-time survivals has no significant difference between two groups in1-year and3-year survivals (P=0.63and0.33respectively) but is significant lower in5-year survival (P<0.01).Conclusion:Although the pancreatectomy combined with vascular resection and reconstruction related with longer operation time and more blood loss, but also larger tumor resection, and it would not increases the perioperative mortality and morbidity. If there is a chance to get RO resection, a better long-time survival could be expected despite of the lower RO resection rate in VR+group. So, here we recommend combined SMV/PV resection and reconstruction in pancreatectomy if there is an RO resection after evaluation.