Optimal intraoperative management in pancreatic surgery: a systematic review of randomized controlled trials

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-08-01 Epub Date: 2026-05-19 DOI:10.1016/j.hpb.2026.05.003

Belkacem Acidi, Alain Sauvanet, Giovanni Marchegianni, Hop S. Tran Cao, Sébastien Gaujoux

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引用次数: 0

Abstract

Background

Despite major advances in pancreatic surgery and reduced mortality, intraoperative management remains poorly standardized and largely dependent on surgeon expertise. This systematic review aimed to synthesise randomized controlled trials evaluating intraoperative surgical techniques in pancreatic surgery and their impact on predefined postoperative outcomes (POPF, DGE, SSI, and length of stay).

Methods

Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, and the Cochrane Database (2013–2024) identified RCTs assessing intraoperative management in pancreatic surgery. Studies focusing on oncologic outcomes or including fewer than 60 patients were excluded. Quality and risk of bias were assessed using the Jadad Scale and the Cochrane RoB-2 tool.

Results

Of 818 articles screened, 47 RCTs met inclusion criteria (Jadad ≥3). Postoperative pancreatic fistula (POPF) was the primary endpoint in 19 studies. Significant POPF reductions were associated with specific techniques such as end-to-side anastomosis, pancreaticogastrostomy, and polyethylene glycol–coated patches. Minimally invasive distal pancreatectomy showed reduced blood loss, hospital stay, and faster recovery. Selective or no-drain policies in distal pancreatectomy were supported by RCTs to reduce clinically relevant POPF.

Conclusion

Intraoperative management in pancreatic surgery remains heterogeneous. Standardized, evidence-based protocols and additional high-quality RCTs are required to optimize surgical techniques and outcomes.

Abstract Image

查看原文本刊更多论文

胰腺手术的最佳术中管理：随机对照试验的系统回顾。

背景：尽管胰腺手术取得了重大进展，降低了死亡率，但术中管理仍然很不规范，很大程度上依赖于外科医生的专业知识。本系统综述旨在综合随机对照试验，评估胰腺手术术中手术技术及其对预定术后结局（POPF、DGE、SSI和住院时间）的影响。方法：遵循PRISMA指南，综合检索PubMed、EMBASE和Cochrane数据库（2013-2024），确定评估胰腺手术术中管理的随机对照试验。关注肿瘤预后或纳入患者少于60例的研究被排除在外。采用Jadad量表和Cochrane rob2工具评估偏倚的质量和风险。结果：在筛选的818篇文章中，47篇rct符合纳入标准（Jadad≥3）。术后胰瘘（POPF）是19项研究的主要终点。特异技术如端侧吻合、胰胃造口术和聚乙二醇包被贴片可显著降低POPF。微创远端胰腺切除术减少了出血量、住院时间和恢复速度。选择性或无引流策略在远端胰腺切除术中得到rct的支持，以减少临床相关的POPF。结论：胰腺手术的术中处理仍然存在差异。需要标准化的、基于证据的方案和额外的高质量随机对照试验来优化手术技术和结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).