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Authors Yang DJ, Xiong JJ, Liu XT, Li J, Dhanushka Layanthi Siriwardena KM, Hu WM
Received 23 November 2018
Accepted for publication 22 March 2019
Published 7 May 2019 Volume 2019:11 Pages 3899—3908
DOI https://doi.org/10.2147/CMAR.S195726
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 3
Editor who approved publication: Dr Beicheng Sun
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.
Keywords: total
pancreatectomy, pancreaticoduodenectomy, morbidity, mortality, meta-analysis