Network Meta-Analysis Of Pancreaticoduodenectomy By Different Surgical Approaches

Objective: To evaluate the effectiveness and safety of pancreatoduodenectomy for periampullary tumors and pancreatic tumors through different surgical approaches by Network Meta-Analysis?Methods:Relevant Chinese and English literatures were obtained by searching WanFang-CSPD,CNKI,SinoMed,PubMed,MEDLINE and other databases and manual retrieval.Date were extracted after screening and evaluating the quality of literature according to the predetermined inclusion criteria and exclusion standard.Finally,ADDIS16.8 software was used to perform Network Meta-Analysis of the data extracted in this study.Results: Nineteen retrospective controlled trials included 1,614 patients in the study.It shows that the model converges well when Potential Scale Reduction Factor(PSRF)are all close to or equal to 1.There is no statistical significance(P>0.05)when inconsistence check under the Node-splitting model.Results of Network Meta-Analysis were shown:In terms of the positive margins rate of surgical approach,The posterior approach is lower than the conventional approach,OR= 0.45,95%CI(0.27,0.73),The difference was statistically significant.The anterior approach to pancreaticoduodenectomy takes longer than the conventional approach,SMD=1.97,95%CI(1.68,2.25),The difference was statistically significant.The incidence of pancreatic fistula in anterior and superior approaches was lower than that in conventional approaches,OR=0.46,95%CI(0.29,0.71);OR=0.26,95%CI(0.07,0.96),The difference was statistically significant.Among the comparisons of intraoperative blood loss,the anterior,posterior,and superior approaches had less intraoperative blood loss than the conventional approaches.SMD=-1.38,95%CI(-1.64,-1.12)?SMD=-3.40,95%CI(-6.50,-0.29);SMD=-1.93,95%CI(-2.62,-1.23),The difference was statistically significant.Among the Network Meta-Analysis comparisons of gastric emptying delays,the delayed gastric emptying rate of the left posterior approach was lower than that of the conventional surgical approach.OR =0.28,95%CI(0.11,0.73),The difference was statistically significant.Conclusion: 1.In pancreaticoduodenectomy,About the positive margins rate of surgical approach,The posterior approach is lower than the conventional approachand.2.In aspect of operative time,The anterior approach takes longer than the conventional approach.3.For the probability of pancreatic fistula between different surgical approaches,the anterior and superior approaches was lower than that in the conventional approaches.4.Comparison of intraoperative blood loss,There are fewer anterior,posterior,and superior approaches than traditional approaches.5.In the network comparison of delayed gastric emptying,The left posterior approach was lower than the conventional surgical approach.