Evidence map›Paper›PMID 39180093›Full record

SynthesisWorld journal of surgical oncology2024

Radicality and safety of total mesopancreatic excision in pancreatoduodenectomy: a systematic review and meta-analysis.

Luís Felipe Leite da Silva, Marcos Belotto, Luiz F Costa de Almeida, Júnior Samuel, Leonardo H Pereira, Rafael Oliveira Albagli, Marcelo Sa de Araujo, Jose M Ramia

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in World journal of surgical oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Luís Felipe Leite da SilvaDepartment of Medical Sciences, Federal Fluminense University, Rio de Janeiro, Brazil. luis_leite@id.uff.br.
Marcos BelottoDepartment of Gastrointestinal Surgery, Hospital 9 de Julho/Dasa, São Paulo, Brazil.
Luiz F Costa de AlmeidaDepartment of Medical Sciences, Federal Fluminense University, Rio de Janeiro, Brazil.
Júnior SamuelDivision of Surgery, Bahia Federal University, Salvador, Brazil.
Leonardo H PereiraDepartment of Medical Sciences, Federal Fluminense University, Rio de Janeiro, Brazil.
Rafael Oliveira AlbagliDepartment of Hepato-Pancreato-Biliary Surgery, National Cancer Institute, Rio de Janeiro, Brazil.
Marcelo Sa de AraujoDepartment of General Surgery, Federal Fluminense University, Niterói, Brazil.
Jose M RamiaDepartment of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Miguel Hernández University, Alicante, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPancreatic head cancer patients who undergo pancreatoduodenectomy (PD) often experience disease recurrence, frequently associated with a positive margin status (R1). Total mesopancreas excision (TMpE) has emerged as a potential approach to increase surgical radicality and minimize locoregional recurrence. However, its effectiveness and safety remain under evaluation.

methodsWe conducted a systematic review and meta-analysis to synthesize current evidence on TMpE outcomes. A systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases was conducted up to March 2024 to identify studies comparing TMpE with standard pancreatoduodenectomy (sPD). The risk ratio (RR) or mean difference (MD) was pooled using a random effects model.

resultsFrom 452 studies identified, 9 studies with a total of 738 patients were included, with 361 (49%) undergoing TMpE. TMpE significantly improved the R0 resection rate (RR 1.24; 95% CI 1.11-1.38; P < 0.05), reduced blood loss (MD -143.70 ml; 95% CI -247.92, -39.49; P < 0.05), and increased lymph node harvest (MD 7.27 nodes; 95% CI 4.81, 9.73; P < 0.05). No significant differences were observed in hospital stay, postoperative complications, or mortality between TMpE and sPD. TMpE also significantly reduced overall recurrence (RR 0.53; 95% CI 0.35-0.81; P < 0.05) and local recurrence (RR 0.39; 95% CI 0.24-0.63; P < 0.05). Additionally, the risk of pancreatic fistula was lower in the TMpE group (RR 0.66; 95% CI 0.52-0.85; P < 0.05).

conclusionTotal mesopancreas excision significantly increases the R0 resection rate and reduces locoregional recurrence while maintaining an acceptable safety profile when compared with standard pancreatoduodenectomy. Further prospective randomized studies are warranted to determine the optimal surgical approach for total mesopancreatic resection.

Indexed as

Pancreatic NeoplasmsPancreaticoduodenectomyHumansMargins of ExcisionNeoplasm Recurrence, LocalPostoperative ComplicationsPrognosisMesopancreasMeta-analysisPancreatoduodenectomySystematic reviewTotal mesopancreas excision

Identifiers

PMID39180093
PMCPMC11342630

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.