| Objective: To evaluate the efficacy and safety of pancreaticoduodenectomy combined with vascular resection for clinician to choose different operation methodin the treatment of pancreatic cancer.Methods: Collecting published in foreign journals of literature about pancreaticoduodenectomy combined vascular reconstruction in the treatment of pancreatic cancer,then Setting standards to screening literatures,at last,the next step is using the Revman5.3 software to analyze the data extracted form literatures.Results: This paper included 34 retrospective study of English literature,a total of10977 patients with pancreatic cancer,including vascular reconstruction group(PD +VR)2308 cases,without vascular reconstruction group(PD-VR)8669 cases,meta analysis results show that there is no statistical differences of theperioperative mortality between PD+VR and PD-VR(OR = 1.36,95% CI(0.99,1.87],P = 0.06),but the incidence of postoperative complications increase in PD+VR group(OR = 1.20,95% CI(1.05,1.37],P = 0.008),there was no statistical difference in 1,3 year survival rate in the two groups,the 5-year survival rate after PD + VR group reduced(OR = 0.45,95%CI(0.26,0.76],P = 0.003),through the analysis of two groups of patients with tumor pathology,PD + VR group compared with PD-VR has large tumor diameter(MD =0.55,95% CI(0.39,0.72)(P < 0.00001),PD +VR group has a higher incidence of lymph node metastasis(OR = 1.23,95% CI(1.02,1.49],P = 0.03),PD+VR group has a higher incidence of nerve invasion(OR = 2.28,95% CI(1.50,3.46],P = 0.0001),the consequence shows that positive surgical margin is risk factor for survival rate(HR =1.61,95% CI(1.38,1.87],P < 0.00001)Conclusion: For patients with the portal vein or superior mesenteric vein invasion in PD+VR group will lead to a higher incidence of postoperative complications,but pancreaticoduodenectomy with vascular resection and reconstruction could attain negative surgical margin which could prolong survival time. |
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