Limited resection vs. pancreaticoduodenectomy for primary duodenal adenocarcinoma: a systematic review and meta-analysis

被引:17
作者
Burasakarn, Pipit [1 ,2 ]
Higuchi, Ryota [1 ]
Nunobe, Souya [3 ]
Kanaji, Shingo [4 ]
Eguchi, Hidetoshi [5 ]
Okada, Ken-ichi [6 ]
Fujii, Tsutomu [7 ]
Nagakawa, Yuichi [8 ]
Kanetaka, Kengo [9 ]
Yamashita, Hiroharu [10 ]
Yamada, Suguru [11 ]
Kuroda, Shinji [12 ]
Aoyama, Toru [13 ]
Akahori, Takahiro [14 ]
Nakagawa, Kenji [14 ]
Yamamoto, Masakazu [1 ]
Yamaue, Hiroki [6 ]
Sho, Masayuki [14 ]
Kodera, Yasuhiro [11 ]
机构
[1] Tokyo Womens Med Univ, Dept Surg, Inst Gastroenterol, Shinjuku Ku, 8-1,Kawada Cho, Tokyo 1628666, Japan
[2] Phramongkutklao Hosp, Dept Surg, Div HPB Surg, Bangkok 10400, Thailand
[3] Ariake Hosp, Inst Canc, Dept Surg Gastroenterol, Koto Ku, 3-8-31 Ariake, Tokyo 1358550, Japan
[4] Kobe Univ, Grad Sch Med, Div Gastrointestinal Surg, Dept Surg,Chuo Ku, 7-5-2 Kusunoki Cho, Kobe, Hyogo 6500017, Japan
[5] Osaka Univ, Grad Sch Med, Dept Surg Gastroenterol, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
[6] Wakayama Med Univ, Sch Med, Dept Surg 2, 811-1 Kimiidera, Wakayama 6418510, Japan
[7] Univ Toyama, Acad Assembly, Dept Surg & Sci, Fac Med, 2630 Sugitani, Toyama 9300194, Japan
[8] Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, 6 Chome 1-1 Shinjuku, Shinjuku City, Tokyo 1608402, Japan
[9] Nagasaki Univ, Grad Sch Biomed Sci, Dept Surg, 1-14 Bunkyomachi, Nagasaki, Japan
[10] Univ Tokyo, Dept Gastrointestinal Surg, Grad Sch Med, Bunkyo Ku, 7-3-1,Hongo, Tokyo 1130033, Japan
[11] Nagoya Univ, Grad Sch Med, Dept Gastroenterol Surg Surg 2, Showa Ku, 65 Tsurumai Cho, Nagoya, Aichi 4668560, Japan
[12] Okayama Univ Hosp, Gastrointestinal Surg Ctr Innovat Clin Med, Kita Ku, 2-5-1 Shikata Cho, Okayama 7008558, Japan
[13] Yokohama City Univ, Dept Surg, Kanazawa Ward, 3 Chome 9 Fukuura, Yokohama, Kanagawa 2360004, Japan
[14] Nara Med Univ, Dept Surg, 840 Shijo Cho, Kashihara, Nara 6348521, Japan
关键词
Duodenal cancer; Duodenal adenocarcinoma; Surgery; Limited resection; Pancreatoduodenectomy; INTERNATIONAL STUDY-GROUP; PANCREAS-SPARING DUODENECTOMY; PROGNOSTIC-FACTORS; CLINICOPATHOLOGICAL ANALYSIS; SURGICAL-TREATMENT; 4TH PORTIONS; SURVIVAL; CARCINOMA; PERIAMPULLARY; MANAGEMENT;
D O I
10.1007/s10147-020-01840-5
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
It is well known that surgery is the mainstay treatment for duodenal adenocarcinoma. However, the optimal extent of surgery is still under debate. We aimed to systematically review and perform a meta-analysis of limited resection (LR) and pancreatoduodenectomy for patients with duodenal adenocarcinoma. A systematic electronic database search of the literature was performed using PubMed and the Cochrane Library. All studies comparing LR and pancreatoduodenectomy for patients with duodenal adenocarcinoma were selected. Long-term overall survival was considered as the primary outcome, and perioperative morbidity and mortality as the secondary outcomes. Fifteen studies with a total of 3166 patients were analyzed; 995 and 1498 patients were treated with limited resection and pancreatoduodenectomy, respectively. Eight and 7 studies scored a low and intermediate risk of publication bias, respectively. The LR group had a more favorable result than the pancreatoduodenectomy group in overall morbidity (odd ratio [OR]: 0.33, 95% confidence interval [CI] 0.17-0.65) and postoperative pancreatic fistula (OR: 0.13, 95% CI 0.04-0.43). Mortality (OR: 0.96, 95% CI 0.70-1.33) and overall survival (OR: 0.61, 95% CI 0.33-1.13) were not significantly different between the two groups, although comparison of the two groups stratified by prognostic factors, such as T categories, was not possible due to a lack of detailed data. LR showed long-term outcomes equivalent to those of pancreatoduodenectomy, while the perioperative morbidity rates were lower. LR could be an option for selected duodenal adenocarcinoma patients with appropriate location or depth of invasion, although further studies are required.
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收藏
页码:450 / 460
页数:11
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