腹腔镜胰十二指肠切除术中非计划转开腹手术对切除边缘和并发症的影响：一项系统回顾和meta回归分析。

IF 1.7 4区医学 Q3 SURGERY

Annals of the Royal College of Surgeons of England Pub Date : 2025-10-01 DOI:10.1308/rcsann.2025.0078

Shahab Hajibandeh, Shahin Hajibandeh, J Alazab, H Alazab, M Safiru, T Satyadas

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引用次数: 0

摘要

简介：我们的目的是研究腹腔镜胰十二指肠切除术中计划外转开腹手术对切除边缘和并发症的影响。方法：采用符合PRISMA陈述标准的随机效应模型进行系统评价和meta分析（比例模型和比较模型）。所有最小样本量为15例患者报告腹腔镜胰十二指肠切除术患者转为开放手术的研究均被纳入。结果包括R0切除，Clavien-Dindo≥3次并发症，30天死亡率。结果：共纳入44项研究，6108例患者。转归率为11.3%（95%置信区间（CI） 9.1-13.5）。转换的原因是出血占27.9%(16.3-39.5%)，技术困难占46.5% (95% CI 33.7-59.4)，肿瘤问题占29.2% (95% CI 18.2-40.2)，医源性损伤占7.7% （95% CI 3.4-12.1）。多变量meta回归分析显示，转换不影响R0切除（系数：-0.228,p=0.307）、Clavien-Dindo并发症≥3例（系数：0.129,p=0.609）和30天死亡率（系数：-0.013,p=0.647）。结果不受转换原因的影响。比较荟萃分析显示，转换不影响R0切除（风险差异（RD）： -0.07, 95% CI -0.17-0.03, p=0.18）， Clavien-Dindo≥3并发症（优势比：2.17,95% CI 0.67-6.99, p=0.20）和30天死亡率（RD: 0.02, 95% CI -0.04-0.07, p=0.57）。结论：在腹腔镜胰十二指肠切除术中，不论转换的原因如何，非计划转换为开放手术可能不会影响切除边缘和并发症（中等确定性）。腹腔镜胰十二指肠切除术中的转换不应被视为失败，因为它对结果没有负面影响；然而，如果在指示时不转换，无疑会产生负面影响。

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Effect of unplanned conversion to open surgery on resection margins and complications in laparoscopic pancreaticoduodenectomy: a systematic review and meta-analysis with meta-regression.

Introduction: We aimed to investigate the effect of unplanned conversion to open surgery during laparoscopic pancreaticoduodenectomy on resection margins and complications.

Methods: A systematic review and meta-analysis (proportion and comparison models) with meta-regression using random-effects modelling compliant with PRISMA statement standards was conducted. All studies with a minimum sample size of 15 patients reporting conversion to open surgery in patients undergoing laparoscopic pancreaticoduodenectomy were included. The outcomes included R0 resection, Clavien-Dindo ≥3 complications, and 30-day mortality.

Findings: A total of 44 studies comprising 6,108 patients were included. Conversion occurred in 11.3% (95% confidence interval (CI) 9.1-13.5). The reason for conversion was bleeding in 27.9% (16.3-39.5%), technical difficulties in 46.5% (95% CI 33.7-59.4), oncological concerns in 29.2% (95% CI 18.2-40.2) and iatrogenic injuries in 7.7% (95% CI 3.4-12.1). Multivariable meta-regression analysis showed that conversion did not affect R0 resection (coefficient: -0.228, p=0.307), Clavien-Dindo ≥3 complications (coefficient: 0.129, p=0.609) and 30-day mortality (coefficient: -0.013, p=0.647). The outcomes were not affected by the reasons for conversion. Comparison meta-analysis showed that conversion does not affect R0 resection (risk difference (RD): -0.07, 95% CI -0.17-0.03, p=0.18), Clavien-Dindo ≥3 complications (odds ratio: 2.17, 95% CI 0.67-6.99, p=0.20) and 30-day mortality (RD: 0.02, 95% CI -0.04-0.07, p=0.57).

Conclusions: Unplanned conversion to open surgery, regardless of the reason for conversion, may not affect resection margins and complications in laparoscopic pancreaticoduodenectomy (moderate certainty). Conversion during laparoscopic pancreaticoduodenectomy should not be seen as a failure because it has no negative impact on outcomes; however, not converting when indicated will undoubtedly have negative impact.

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来源期刊

Annals of the Royal College of Surgeons of England Medicine-Surgery

CiteScore

2.40

自引率

0.00%

发文量

316

期刊介绍： The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.