Periarterial Divestment in Locally Advanced Pancreatic Cancer: Systematic Review and Single-Arm Meta-Analysis.
Philipe Franco do Amaral Tafner, Júlia Paiva Behs, Fernanda de Moraes Nava et al.
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In 30 seconds
This systematic review and single-arm meta-analysis assessed perioperative and oncologic outcomes after periarterial divestment for pancreatic cancer. It included five retrospective observational studies with 474 patients; 92.8% had locally advanced disease and 64.8% received neoadjuvant therapy. The pooled R0 resection rate was 43.33%, and pooled 90-day mortality was 4.18%. Reported overall survival was 75.99% at 1 year and 29.11% at 3 years. The authors conclude that the evidence is descriptive and does not support comparisons with other surgical approaches.
Key findings
- Across five studies and 474 patients, the pooled R0 resection rate was 43.33%.
- Pooled 90-day mortality was 4.18%; major complications (Clavien-Dindo grade ≥ III) occurred in 11.27%.
- Pooled overall survival was 75.99% at 1 year and 29.11% at 3 years.
- The pooled incidence of postoperative pancreatic fistula was 8.72%.
Why it matters
Periarterial divestment is an artery-preserving surgical approach used in selected patients with borderline resectable or locally advanced pancreatic cancer. These pooled results provide descriptive estimates of resection, postoperative outcomes, and survival that can inform understanding of the procedure. However, the evidence does not establish whether outcomes are better or worse than with formal arterial resection or other approaches.
What to keep in mind
The analysis included only five retrospective observational studies, and the authors state that the evidence is descriptive and does not allow comparative inference. Several pooled perioperative estimates showed substantial heterogeneity.