<p>Total pancreatectomy compared with pancreaticoduodenectomy: a systematic review and meta-analysis</p>

Abstract

Aim: To assess whether total pancreatectomy (TP) is as feasible, safe, and efficacious as pancreaticoduodenectomy (PD). Materials and Methods: Major databases, including PubMed, EMBASE, Science Citation Index Expanded, Scopus and the Cochrane Library, were searched for studies comparing TP and PD between January 1943 and June 2018. The meta-analysis only included studies that were conducted after 2000. The primary outcomes were morbidity and mortality. Pooled odds ratios (ORs), weighted mean differences (WMDs) or hazard ratios (HRs) with 95 percent confidence intervals (CIs) were calculated using fixed effects or random effects models. The methodological quality of the included studies was evaluated by the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results: In total, 45 studies were included in this systematic review, and 5 non-randomized comparative studies with 786 patients (TP: 270, PD: 516) were included in the meta-analysis. There were no differences in terms of mortality (OR: 1.44, 95% CI: 0.66–3.16; P =0.36), hospital stay (WMD: −0.60, 95% CI: −1.78–0.59; P =0.32) and rates of reoperation (OR: 1.12; 95% CI: 0.55–2.31; P =0.75) between the two groups. In addition, morbidity was not significantly different between the two groups (OR: 1.41, 95% CI: 1.01–1.97; P =0.05); however, the results showed that the TP group tended to have more complications than the PD group. Furthermore, the operation time (WMD: 29.56, 95% CI: 8.23–50.89; P =0.007) was longer in the TP group. Blood loss (WMD: 339.96, 95% CI: 117.74–562.18; P =0.003) and blood transfusion (OR: 4.86, 95% CI: 1.93–12.29; P =0.0008) were more common in the TP group than in the PD group. There were no differences in the long-term survival rates between the two groups. Conclusion: This systematic review and meta-analysis suggested that TP may not be as feasible and safe as PD. However, TP and PD may have the same efficacy.

MiR-10a in Pancreatic Juice as a Biomarker for Invasive Intraductal Papillary Mucinous Neoplasm by miRNA Sequencing

“…Further, 9% of patients with malignant IPMN would be treated as low risk, and their diagnoses would be missed [ 12 , 13 , 14 ]. Conversely, pancreaticoduodenectomy and total pancreatectomy are relatively invasive treatments with treatment-related mortalities of 0–4.9% and 0–8%, respectively, and they require careful indication [ 15 , 16 , 17 ]. Additional malignant predictors, including new biomarkers, are required to select an optimal treatment for IPMN.…”

Total Pancreatectomy is as Feasible and Safe as Pancreatico-duodenectomy

“…Oncologically, median number of lymph nodes harvested was significantly higher in the TP group 20 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) vs. 15 (11)(12)(13)(14)(15)(16)(17)(18)(19)) (p-0.003). In patients with malignant disease positive resection margins (R1) was observed in 3.4% (n-6) of the patients in the PD group and in 2.9% (n-1) of the TP group (p-0.88).…”

“…Hartwig et al published the short and long term outcome of 434 total pancreatectomies for pancreatic and peri-ampullary tumors and concluded that TP is justified by improved survival rates, acceptable quality of life and stable vitamins and HbA1 C levels (11). Currently, no randomized control trials comparing PD with TP have been reported in the English literature, but several retrospective comparative studies and meta-analyses addressed this issue in the past with controversial results (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Patient selection for TP remain a difficult choice and the purpose of the current study is to evaluate weather TP is as feasible and safe as PD in terms of morbidity and mortality.…”

Hemangioma of the major duodenal papilla complicated with bleeding

“…Массивная кровопотеря во время операции у пожилого, исходно анемизированного пациента с факторами риска, к сожалению, привели через ряд осложнений к неблагоприятному исходу. Несмотря на то что у операции Уиппла по-прежнему высоки показатели послеоперационных осложнений и летальности [13][14][15], наряду с низкими показателями долгосрочной выживаемости [16,17], панкреатодуоденальная резекция показана при любых подозрительных опухолеподобных поражениях периампулярной зоны [6]. Неожиданные результаты окончательного гистологического исследования лишь подчеркивают, что в сомнительных случаях дифференциального диагноза хирургический метод остается золотым стандартом [6].…”