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Central pancreatectomy: a comprehensive, up-to-date meta-analysis

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Abstract

Background

Central pancreatectomy (CP) is the alternative to distal pancreatectomy (DP) for specific pathologies of the mid-pancreas. However, the benefits of CP over DP remain controversial. This study aims to compare the two procedures by conducting a meta-analysis of all published papers.

Methods

A systematic search of original studies comparing CP vs. DP was performed using PubMed, Scopus, and Cochrane Library databases up to June 2018. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist was followed.

Results

Twenty-one studies were included (596 patients with CP and 1070 patients with DP). Compared to DP, CP was associated with significantly higher rates of overall and severe morbidity (p < 0.0001), overall and clinically relevant pancreatic fistula (p < 0.0001), postoperative hemorrhage (p = 0.02), but with significantly lower incidences of new-onset (p < 0.0001) and worsening diabetes mellitus (p = 0.004). Furthermore, significantly longer length of hospital stay (p < 0.0001) was observed for CP patients.

Conclusions

CP is superior to DP regarding the preservation of pancreatic functions, but at the expense of significantly higher complication rates and longer hospital stay. Proper selection of patients is of utmost importance to maximize the benefits and mitigate the risks of CP.

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Acknowledgments

The authors thank Mr. William Ruixian He for critically reading the manuscript.

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Authors and Affiliations

  1. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Mihnea P. Dragomir, George E. D. Petrescu & Traian Dumitrascu

  2. Department of General Surgery and Liver Transplantation, Division of Surgical Oncology, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 022328, Bucharest, Romania

    Mihnea P. Dragomir & Traian Dumitrascu

  3. Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mihnea P. Dragomir

  4. Department of Pediatrics, “Marie S. Curie” Emergency Clinical Hospital for Children, Bucharest, Romania

    Alexandru A. Sabo

  5. Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People’s Republic of China

    Yongfeng Li

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  1. Mihnea P. Dragomir
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  2. Alexandru A. Sabo
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  4. Yongfeng Li
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  5. Traian Dumitrascu
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Contributions

Study design: Traian Dumitrascu. Acquisition of data: Mihnea P. Dragomir, Alexandru A. Sabo, George E.D. Petrescu, Traian Dumitrascu. Analysis and interpretation of data: Mihnea P. Dragomir, Alexandru A. Sabo, George E.D. Petrescu, Yongfeng Li, Traian Dumitrascu. Drafting the manuscript: Mihnea P. Dragomir, Alexandru A. Sabo, George E.D. Petrescu, Traian Dumitrascu. Critical revision of the work for important intellectual content: Mihnea P. Dragomir, Alexandru A. Sabo, George E.D. Petrescu, Yongfeng Li, Traian Dumitrascu. Final approval of the version to be published: Mihnea P. Dragomir, Alexandru A. Sabo, George E.D. Petrescu, Yongfeng Li, Traian Dumitrascu. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Mihnea P. Dragomir, Alexandru A. Sabo, George E.D. Petrescu, Yongfeng Li, Traian Dumitrascu.

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Correspondence to Traian Dumitrascu.

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Dragomir, M.P., Sabo, A.A., Petrescu, G.E.D. et al. Central pancreatectomy: a comprehensive, up-to-date meta-analysis. Langenbecks Arch Surg 404, 945–958 (2019). https://doi.org/10.1007/s00423-019-01829-3

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