微创与开腹胰体尾切除治疗胰腺癌疗效比较的meta分析

摘要

目的 用meta分析方法,系统评价微创胰体尾切除(MIDP)与开腹胰体尾切除(ODP)治疗胰腺癌的疗效.方法 检索PubMed,Medline、Web of Science和Cochrane library等数据库,查找从建库到2017年6月发表的关于MIDP与ODP治疗胰腺癌疗效的随机和临床对照试验.筛查文献、提取资料、评价质量后,采用RevMan 5.3软件进行Meta分析.结果 MIDP组术后3年和5年生存率要大于ODP组,差异有统计学意义[(RR,1.24;95％ CI,1.14-1.35;P＜0.00001);(RR,1.33;95％ CI,1.19-1.49;P＜0.00001)];在肿瘤切缘阳性率、住院时间、术后禁食时间、术中出血量、输血率方面,MIDP组小于ODP[(RR,0.72;95％ CI,0.60-0.87;P=0.008);(标准化均数差[SMD],-0.38;95％CI,-0.47 to-0.29;P＜0.0001);(SMD,-1.02;95％CI,-1.95 to-0.46;P=0.0004);(SMD,-0.59;95％ CI,-0.82 to-0.3;P＜0.00001);(RR,0.39;95％ CI,0.28-0.55;P ＜0.0001)].结论 对于胰腺癌患者,MIDP相较于ODP具有一定的安全性和可行性.%Objective Background:Minimally invasive distal pancreatectomy(MIDS) has been an effective and safe surgical for treating benign and borderline distal pancreatic tumors,but data for pancreatic cancer are still limited.So,a meta analysis was used to evaluate the clinical efficacy of minimally invasive pancreatectomy (MIDP) and open pancreatectomy (ODP) in the treatment of pancreatic cancer.Methods A systematic review of the studies comparing MIDP and ODP was conducted through search PubMed,Medline,Web of Science and Cochrane library.Data were extracted by two reviewers independently.The statistical analysis was carried out using Review Manager Version 5.3 (The Nordic Cochrane Centre,Copenhagen,Denmark).The primary endpoint was 3-years and 5-years overall survival(OS),pancreatic fistula,morbidity,resection margin positive(R1) and length of stay(LOS).The secondary endpoints were intra-and postoperative results,the number of lymph node harvested,lymph node positive,recurrence rate,and adjuvant chemotherapy.Results 13 studies involving 5970 patients (22.1％ minimally invasive and 77.9％ open) were identified and selected for evaluation.Meta-analysis showed that MIDP had higher 3-years OS (risk ratio [RR],1.24;95％ confidence interval [CI],1.14-1.35;P＜0.00001) and 5-years OS (RR,1.33;95％CI,1.19-1.49;P＜0.00001),lowerR1 rate (RR,0.72;95％ CI,0.60-0.87;P =0.008),shorter LOS (standardized mean difference [SMD],-0.38;95％ CI,-0.47 to-0.29;P ＜ 0.0001),first oral time (SMD,-1.02;95 ％ CI,-1.95 to-0.46;P =0.0004),less estimated blood loss (EBL) (SMD,-0.59;95 ％ CI,-0.82 to-0.3;P ＜ 0.00001),lower tansfusion rate (RR,0.39;95 ％ CI,0.28-0.55;P ＜ 0.0001),and fewer 90-days mortality (RR,0.49;95％ CI,0.26-0.93;P =0.03) compared to ODP.However,the meta-analysis showed that these outcomes of MIDP versus ODP for treatment of pancreatic cancer were comparable in terms of pancreatic fistula,morbidity,operative time,reoperation,30-days readmission,lymph node number harvested,lymph node positive,30-days mortality,recurrence,and adjuvant chemotherapy.Conclusion This meta-analysis indicates the potential advantage of MIDP in improving the 3-and 5-year OS rates,R1 rate,LOS,and mortality.