Effectiveness and safety of central pancreatectomy in benign or low-grade malignant pancreatic body lesions: a systematic review and meta-analysis

The best approach for treating benign or low-grade malignant lesions localized in the pancreatic neck or body remains debatable. Conventional pancreatoduodenectomy and distal pancreatectomy (DP) are associated with a risk of impairment of pancreatic function at long-term follow-up. With advances in technology and surgical skills, the use of central pancreatectomy (CP) has gradually increased. OBJECTIVES: The objective was to compare the safety, feasibility, and short-term and long-term clinical benefits of CP and DP in matched cases. METHODS: The PubMed, MEDLINE, Web of Science, Cochrane, and EMBASE databases were systematically searched to identify studies published from database inception to February 2022 that compared CP and DP. This meta-analysis was performed using R software. RESULTS: Twenty-six studies matched the selection criteria, including 774 CP and 1713 DP cases. CP was significantly associated with longer operative time (P<0.0001), less blood loss (P<0.01), overall and clinically relevant pancreatic fistula (P<0.0001), postoperative hemorrhage (P<0.0001), reoperation (P=0.0196), delayed gastric emptying (P=0.0096), increased hospital stay (P=0.0002), intra-abdominal abscess or effusion (P=0.0161), higher morbidity (P<0.0001) and severe morbidity (P<0.0001) but with a significantly lower incidence of overall endocrine and exocrine insufficiency (P<0.01), and new-onset and worsening diabetes mellitus (P<0.0001) than DP. CONCLUSIONS: CP should be considered as an alternative to DP in selected cases such as without pancreatic disease, length of the residual distal pancreas is more than 5 cm, branch-duct intraductal papillary mucinous neoplasms, and a low risk of postoperative pancreatic fistula after adequate evaluation.