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| Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis |
| Ionut Negoi, Sorin Hostiuc, Alexandru Runcanu, Ruxandra Irina Negoi and Mircea Beuran |
Author Affiliations: General Surgery Department, Emergency Hospital of Bucharest (Negoi I, Runcanu A and Beuran M); National Institute of Legal Medicine Mina Minovici (Hostiuc S), and Anatomy Department (Negoi RI), Carol Davila University of Medicine and Pharmacy Bucharest, Romania
Corresponding Author: Ionut Negoi, MD, PhD, Senior Lecturer of Surgery, General Surgery Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, No 8 Floreasca Street, Sector 1, 014461, Bucharest, Romania (Tel: +40723209910; Fax: +40215992257; Email: negoiionut@gmail.com) |
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Abstract BACKGROUND: The superior mesenteric artery (SMA) first approach was proposed recently as a new modification of the standard pancreaticoduodenectomy. Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenectomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pancreaticoduodenectomy (SMA-PD) with standard pancreaticoduodenectomy (S-PD).
METHODS: Electronic search of the PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Library was performed until July 2015. We considered randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) comparing SMA-PD with S-PD to be eligible if they included patients with periampullary cancers.
RESULTS: A total of one RCT and thirteen NRCSs met the inclusion criteria, involving 640 patients with SMA-PD and 514 patients with S-PD. The SMA-PD was associated with less intraoperative bleeding, less blood transfusions and higher rate of associated venous resections. The pancreatic fistula and delayed gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complication rates and in-hospital mortality. There was no difference regarding R0 resection rate, and one-, two- or three-year overall survival. The SMA-PD was associated with a lower local, hepatic and extrahepatic metastatic rate.
CONCLUSIONS: The SMA-PD is associated with better perioperative outcomes, such as blood loss, transfusion requirements, pancreatic fistula, and delayed gastric emptying. Although the one-, two- or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic recurrence rate.
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2017, Vol. 16 
