Obstructive pancreatitis is a stronger fibrogenic stimulus than cancer-specific stellate cell activation in pancreatic ductal adenocarcinoma

Kurtoğlu, Metin; Schlitter, Anna Melissa; Göklemez, Sencer; Büdeyri, Ibrahim; Tesfay, Temesgen; Gürses, Bengı; Kapran, Yersu; Freiss, Helmut; Espósito, Irene; Kleeff, Jörg; Erkan, Mert

doi:10.1016/j.pan.2016.05.123

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“…Interestingly, lower fistula incidence was reported among the patients with arterial resection, probably due to more advanced tumors and hence more solidified postobstructive fibrosis [56].…”

Section: Mortalitymentioning

confidence: 99%

Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

Rebelo

Büdeyri

Heckler

et al. 2020

Langenbecks Arch Surg

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Objective Advances in multimodality treatment paralleled increasing numbers of complex pancreatic procedures with major vascular resections. The aim of this meta-analysis was to evaluate the current outcomes of arterial resection (AR) in pancreatic surgery. Methods A systematic literature search was carried out from January 2011 until January 2020. MOOSE guidelines were followed. Predefined outcomes were morbidity, pancreatic fistula, postoperative bleeding and delayed gastric emptying, reoperation rate, mortality, hospital stay, R0 resection rate, and lymph node positivity. Duration of surgery, blood loss, and survival were also analyzed. Results Eight hundred and forty-one AR patients were identified in a cohort of 7111 patients. Morbidity and mortality rates in these patients were 66.8% and 5.3%, respectively. Seven studies (579 AR patients) were included in the meta-analysis. Overall morbidity (48% vs 39%, p = 0.1) and mortality (3.2% vs 1.5%, p = 0.27) were not significantly different in the groups with or without AR. R0 was less frequent in the AR group, both in patients without (69% vs 89%, p < 0.001) and with neoadjuvant treatment (50% vs 86%, p < 0.001). Weighted median survival was shorter in the AR group (18.6 vs 32 months, range 14.8–43.1 months, p = 0.037). Conclusions Arterial resections increase the complexity of pancreatic surgery, as demonstrated by relevant morbidity and mortality rates. Careful patient selection and multidisciplinary planning remain important.

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Section: Mortalitymentioning

confidence: 99%