TABLE 1.
Baseline Characteristics
| Study | Inclusion period | Design | TP (n) | Extended, n (%) | IAT, n (%) | Malignancy, n (%) | PD (n) | Extended, n (%) | Definition high-risk PE, n (%) | Type PE, (%) | Malignancy, n (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Capretti et al (2021)32 * | 2010-2019 | R/S /M– | 27 | VR: 0 (0) | 9 (15) | Unknown | 35 | VR: 2 (6) | FRS ≥7† 39 | PJ‡ (100) | Unknown |
| Hempel et al (2021)34 § | 2008-2017 | R/S/M– | 41 | PVR: 23 (57) AR: 19 (46) MV: 16 (39) |
Unknown | 41 (100) | 39 | PVR: 25 (64) AR: 0 (0) MV: 0 (0) |
aFRS >20%38 | PJ (97) PG (3) |
39 (100) |
| Luu et al (2021)35 | 2009-2018 | R/S/M+ | 100 | Unknown | Unknown | 67 (67) | 100 | Unknown | Very soft parenchyma + duct <3 mm¶ | PJ∥ (100) | 67 (67) |
| Marchegiani et al (2021)37 | 2017-2019 | R/S/M– | 86# | VR: 33 (38) | Unknown | Unknown | 101 | VR: 5 (5) | aFRS >20%38 | PJ (67) PG (32) |
Unknown |
| Stoop et al (2022)36 | 2015-2017 | R/S/M+ | |||||||||
| Stratum 1: | 41 | PVR: 30 (73) AR: 0 (0) MV: 17 (42) |
0 (0) | 35 (85) | 18 | PVR: 10 (56) AR: 0 (0) MV: 5 (28) |
Soft parenchyma and/or duct ≤3 mm | PJ (100) | 18 (100) | ||
| Stratum 2: | 24 | PVR: 6 (25) AR: 0 (0) MV: 2 (8) |
0 (0) | 16 (67) | 36 | PVR: 5 (14) AR: 0 (0) MV: 0 (0) |
Soft parenchyma and/or duct ≤3 mm | PJ (100) | 17 (47) | ||
| Stratum 3: | 12 | PVR: 0 (0) AR: 0 (0) MV: 0 (0) |
0 (0) | 9 (75) | 48 | PVR: 0 (0) AR: 0 (0) MV: 0 (0) |
Soft parenchyma and/or duct ≤3 mm | PJ (100) | 38 (79) | ||
| Balzano et al (2022)33 * | 2010-2019 | P/M/RCT | 30 | Unknown | 28 (93) | 21 (70) | 31 | Unknown | Soft parenchyma and duct ≤3 mm | PJ (100)∥ | 24 (77) |
Overlapping cohorts.
Patients in both the PD and TP group had an FRS ≥7. All TPs were initially scheduled as PD and intraoperatively converted because of pancreatic features and clinical condition.
Two-layer end-to-side pancreaticojejunostomy.
The PD population differs from the primary publication, since that primary publication34 does not describe the outcomes from the patients who underwent a PD with high-risk PE separately. Therefore, the Hempel et al provided the data that meets the inclusion criteria of the present systematic review
Double-layer end-to-side duct-to-mucosa pancreaticojejunostomy.
Patients in both the PD and TP group had a very soft pancreatic remnant + pancreatic duct size <3 mm. TP was mainly performed because of the pancreatic remnant was found technically unsuitable for a safe anastomosis due to soft and friable pancreatic texture combined with small-sized pancreatic duct.
All TPs were preoperatively scheduled as PD, but were intraoperatively converted to TP because of positive neck margin (49%), technical issues (27%), vascular resection/reconstruction (14%), or other reasons (10%; pancreatitis, bleeding, and iatrogenic splenic laceration).
aFRS indicates alternative fistula risk score; AR, arterial resection; mm, millimetres; IAT, islet-autotransplantation; M, multicentre; M-, no matching; M+, matching; n, number of patients; P, prospective study; PD, pancreatoduodenectomy; PE, pancreatico-enterostomy; PJ, pancreatojejunostomy; PVR, portomesenteric venous resection; R, retrospective study; RCT, randomized controlled trial; S, single-centre study; TP, total pancreatectomy, VR, vascular resection.