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Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: Impact on margin status and survival

Lookup NU author(s): Sanjay PandanaboyanaORCiD


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© 2017 Elsevier LtdIntroduction The benefit of portal-superior mesenteric vein resection (PSMVR) with pancreatoduodenectomy (PD) remains controversial. This study assesses the impact of PSMVR on resection margin status and survival. Method An electronic search was performed to identify relevant articles. Pooled odds ratios were calculated for outcomes using the fixed or random-effects models for meta-analysis. A decision analytical model was developed for estimating cost effectiveness. Results Sixteen studies with 4145 patients who underwent pancreatoduodenectomy were included: 1207 patients had PSMVR and 2938 patients had no PSMVR. The R1 resection rate and post-operative mortality was significantly higher in PSMVR group (OR1.59[1.35, 1.86] p=<0.0001, and OR1.72 [1.02,2.92] p = 0.04 respectively). The overall survival at 5-years was worse in the PSMVR group (HR0.20 [0.07,0.55] P = 0.020). Tumour size (p = 0.030) and perineural invasion (P = 0.009) were higher in the PSMVR group. Not performing PSMVR yielded cost savings of $1617 per additional month alive without reduction in overall outcome. Conclusion On the basis of retrospective data this study shows that PD with PSMVR is associated with a higher R1 rate, lower 5-year survival and is not cost-effective. It appears that PD with PSMVR can only be justified if R0 resection can be achieved. The continuing challenge is accurate selection of these patients.

Publication metadata

Author(s): Bell R, Ao BT, Ironside N, Bartlett A, Windsor JA, Pandanaboyana S

Publication type: Review

Publication status: Published

Journal: Surgical Oncology

Year: 2017

Volume: 26

Issue: 1

Pages: 53-62

Print publication date: 01/03/2017

Online publication date: 10/01/2017

Acceptance date: 29/12/2016

ISSN (print): 0960-7404

ISSN (electronic): 1879-3320

Publisher: Elsevier Ltd


DOI: 10.1016/j.suronc.2016.12.007

PubMed id: 28317585