Pancreatectomy Combined with Arterial Resection for Pancreatic Carcinoma with Arterial Infiltration: A Meta-analysis

Pancreatic carcinoma (PC) easily invades the peripancreatic arteries, which is the main reason for the poor prognosis. This meta-analysis aimed to investigate the perioperative outcomes and long-term survival of pancreatectomy combined with arterial resection (AR) in PC patients with arterial infiltration. We searched the Medline, EMbase, and Cochrane Library and used the Review Manager 5.3. A total of 11 studies were reviewed, including 1829 patients who underwent pancreatectomy or palliative therapies, of whom 205 received AR. The results showed that AR was associated with a longer operation time (MD = 87.05,P < 0.00001), higher blood loss (MD = 422.73,P < 0.00001), and an increased risk for overall complication (OR = 2.10,P < 0.0001), postpancreatectomy hemorrhage (PPH) (OR = 3.32,P = 0.003), and reoperation (OR = 2.38,P = 0.001). The occurrence of postoperative pancreatic fistula (POPF) (OR = 1.66,P = 0.05), delayed gastric emptying (DGE) (OR = 2.15,P = 0.13), and perioperative mortality (OR = 1.94,P = 0.06) seemed higher in AR group. Pancreatectomy with AR showed a better survival at 1 year (OR = 1.55,P = 0.05), 3 years (OR = 1.78,P = 0.04), and 5 years (OR = 3.24,P = 0.03). Therefore, we concluded that pancreatectomy with AR could be conducted under the comprehensive consideration of patients' conditions, and it may be especially beneficial for those who have the probability to achieve R0 resection.