Extended distal pancreatectomy in pancreatic cancer: is it justified? A systematic review of literature

Abstract

Background: Extended distal pancreatectomy (EDP) is being increasingly performed for pancreatic cancers with suspected invasion into the adjacent organs. However, the perioperative safety and oncological efficacy of this procedure merit further elucidation. Methods: Major databases were searched for studies evaluating EDP, and a meta-analysis was performed using fixed- or random-effects models. Results: Fifteen studies were included in the analysis. EDP was found to be associated with significantly greater incidence of postoperative pancreatic fistula overall and with major complications, re-explorations, mortality and readmissions. However, on pooled analysis of 3- and 5-year survival, EDP was found to be noninferior to standard distal pancreatectomy. Conclusion: EDP is feasible and may offer equivalent survival in highly selected patients but carries a higher risk of perioperative morbidity and mortality.

Keywords::

• distal pancreatectomy
• extended resections
• outcomes
• pancreatic cancer
• survival

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/fon-2022-1180

Author contributions

S Chandrashekhar: selection of studies, interpretation of data and drafting of the manuscript. S Ismail: selection of studies, interpretation of data and drafting of the manuscript. P Jonnada: selection of studies, interpretation of data, statistical analysis and final approval. B Senadhipan: critical review and final approval. M Karunakaran: conceptualization of the manuscript, design of the study, interpretation of data, drafting of the manuscript and final approval. S Barreto: conceptualization of the manuscript, interpretation of data, critical review and final approval.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.