Short-Term Outcomes of Arterial Divestment in Pancreatic Cancer: A Systematic Review and Single Arm Meta-Analysis of Observational Studies.

[BACKGROUND] The present study aimed to review and analyze the impact of arterial divestment during pancreatic surgery on short-term outcomes.

[METHODS] PubMed, Embase, Web of Science, and the Cochrane Library were searched. Outcomes of interest included perioperative parameters, resection margins, morbidity, and mortality. Analysis was performed using the meta package in R.

[RESULTS] Five observational studies comprising 554 patients were included. Two hundred twelve patients had upfront surgery, and 342 patients had neoadjuvant chemotherapy. Four hundred and eighty-two had periarterial dissection and 72 sub adventitial dissection. Operative time varied considerably (median 185-537 min), and intraoperative blood loss ranged between 300 and 900 mL. The pooled prevalence of blood transfusion was 37.6% (95% CI: 32.5%-43.1%; I = 97.7%). Median post-operative stay ranged from 7 to 25 days. R0 resection was achieved in 49.4% (95% CI: 44.9%-53.8%). Complications included post-operative pancreatic fistula (9.2%), delayed gastric emptying (11.2%), post-operative pancreatic hemorrhage (5.8%), chyle leakage (13.9%), reoperation (6.1%), 90-day mortality (3.1%), bile leakage (≤ 2.8%), ischemia (≤ 4.2%), and intractable diarrhea (8%-13%).

[CONCLUSIONS] Arterial divestment during pancreatic surgery appears to have acceptable morbidity and mortality. However, there is a lack of a unified agreed definition and case selection. A unified reporting, standardization of terminology and relative role compared to arterial resection should be explored in prospective studies.