Systematic Review of Central Pancreatectomy “the Dagradi-Serio-Iacono Operation” and Meta-Analysis Versus Distal Pancreatectomy
Calogero Iacono*1, Giuseppe Verlato2, Andrea Ruzzenente1, Tommaso Campagnaro1, Alessandro Valdegamberi1, Luca Bortolasi1, Chiara Tezza1, Alfredo Guglielmi1
1Department of Surgery, University of Verona Medical School, Verona, Italy; 2Unit of Epidemiology & Medical Statistics Dept. of Medicine & Public Health, Verona, Italy
BACKGROUND: Central Pancreatectomy (CP), first described by Dagradi and Serio in 1984 and popularized worldwide by Iacono, is a parenchyma-sparing surgical procedure that allows removing benign and/or low grade malignant lesion from the neck and proximal body of pancreas. The aim of the study was to evaluate, from all published studies, short and long term surgical results of CP and to evaluate results of comparative studies versus distal pancreatectomy (DP).METHODS: All published studies between 1988 and october 2010 were systematically reviewed. Results of comparative studies, comparing CP versus DP, were pooled by standard meta-analytic techniques using the random effects model.RESULTS: Eighty-nine studies with 939 cases of CP were recognized and included in the systematic review. Nine-hundred and nine open resection were performed, 30 laparoscopic, 11 of whom were robotic assisted. Postoperative morbidity rate was 39,37%; pancreatic fistula rate was 30%. Endocrine and exocrine pancreatic insufficiency were reported in 4,5% and 8% of patients, respectively. Overall mortality rate was 0,92%. Ten comparative studies, including 309 patients submitted to central pancreatectomy and 430 to distal pancreatectomy, were analyzed for meta-analysis. Surgical operation time, blood loss, length of stay, morbidity and exocrine failure presented a significant heterogeneity across studies, with the I-squared ranging from 49.4% to 93.8%; re-operation, endocrine failure and pancreatic fistula did not presented significant heterogeneity. Central pancreatectomy had a higher post-operative morbidity (pooled RR=1.56, 95% CI 1.09-2.21), with higher incidence of pancreatic fistula (pooled RR=1.70, 95% CI 1.31-2.19) compared to distal pancreatectomy. However, the odds ratio for post-operative endocrine insufficiency was 0.26 (95% CI 0.16-0.41), revealing a statistically significant benefit to CP (p<0.001). The odds ratio for exocrine failure was 0.59 (95% CI 0.33-1.07), but it was not significant (p=0.084) because of the large heterogeneity among studies (I-squared 64.4%).CONCLUSION: Systematic review and meta-analysis, confirmed central pancreatectomy as a safe surgical procedure with good long term functional reserve although with a low increasing of morbidity (pancreatic fistula) when compared to distal pancreatectomy.
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