Introduction
Material and methods
Eligibility criteria
Information source, search, study selection, and data collection process
Data items and risk of bias in individual study
Summary measurements and synthesis of the results
Risk of bias across studies and meta-regression analysis
Results
Studies selected
Study characteristics and risk of bias within studies
First Author/year | Affiliation/country | Classification of aberrant RHA | Type of surgeon | Rep RHA/CHA or CMT | RHA resected | RHA injured | RHA reconstructed | PDAC RR | MINORS |
---|---|---|---|---|---|---|---|---|---|
Jah et al. [24] | Department of Hepatobiliary and Transplant Surgery, Addenbrooke’s Hospital, Cambridge (UK) | Unstandardized | HPB | – | 3/28 (10.7) | 0/28 (0) | 1/28 (3.6) | 0.97 (0.55 to 1.70) | 17 |
Lee et al. [25] | Department of Surgery, Ajou University School of Medicine, Suwon, (Republic of Korea) | Unstandardized | Unspecified | – | 0/15 (0) | 0/15 (0) | 0/15 (0) | – | 18 |
Eshuis et al. [26] | Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands | Michels/Hiatt | Unspecified | 117 | 8/143 (5.6) | 2/143 (1.4) | 2/143 (1.4) | 0.91 (0.72 to 1.15) | 19 |
Perwaiz et al. [27] | Department of Surgical Gastroenterology, Sir Ganga Ram Hospital. New Delhi (India) | Michels | Unspecified | 30 | – | – | – | – | 18 |
Turrini et al. [28] | Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, (USA) | Michels | Unspecified | 44 | 3/47 (6.4) | 0/47 (0) | 2/47 (4.2) | 1.00 (0.95 to 1.05) | 19 |
Sulpice et al. [29] | Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes (France) | Michels | P | – | 6/29 (20.7) | 0/29 (0) | 2/29 (6.9) | 1.05 (0.77 to 1.45) | 19 |
Kim et al. [30] | Departments of Surgical Oncology and Princess Margaret Cancer Center, Toronto, (Canada) | Michels | HPB | 34 | 5/37 (13.5) | 1/37 (2.7) | 1/37 (2.7) | 1.00 (0.96 to 1.04) | 18 |
Rammohan et al. [31] | Surgical Gastroenterology and Liver Transplantation, College Hospital, Chennai, (India) | Michels | HPB | 32 | 8/43 (18.6) | 0/43 (0) | 1/43 (2.3) | 0.98 (0.43 to 2.25) | 19 |
Dorado et al. [32] | HBP Surgery and Liver Transplantation Unit. Sevilla, (Spain) | Unstandardized | HPB | 9 | 1/11 (9.1) | 0/11 (0) | 1/11 (9.1) | 1.05 (0.54 to 2.06) | 16 |
Nguyen et al. [33] | Division of Gastrointestinal Surgical Oncology, Department of Surgery, Medical Center, Pittsburgh, PA, (USA) | Michels | P | 29 | 0/30 (0) | 0/30 (0) | 0/30 (0) | 0.77 (0.36 to 1.64) | 19 |
Kim et al. [34] | Division of Pancreatobiliary Surgery, Department of Surgery, (Republic of Korea) | Unstandardized | P | 11 | 2/15 (13.3) | 0/15 (0) | 0/15 (0) | – | 20 |
Trofin et al. [35] | “Sf. Spiridon” County Clinical Emergency Hospital, Iasi (Romania) | Michels | Unspecified | 28 | 4/45 (8.9) | 2/45 (4.4) | 2/45 (4.4) | – | 19 |
Sanchez et al. [36] | Digestive Surgery Unit, Catholic University School of Medicine, Rome, (Italy) | Michels | P | 25 | 0/25 (0) | 0/25 (0) | 0/25 (0) | – | 17 |
Alexakis et al. [37] | Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, (Greece) | Unstandardized | Unspecified | – | 5/35 (14.2) | 3/35 (8.6) | 3/35 (8.6) | 0.92 (0.69 to 1.22) | 18 |
Crocetti et al. [38] | Pietro Valdoni Department of Surgery, Sapienza University of Rome, Rome, (Italy) | Unstandardized | P | – | 0/44 (0) | 0/44 (0) | 0/44 (0) | 1.00 (0.97 to 1.03) | 19 |
Khang et al. [39] | Department of Surgery, Aga Khan University, Karachi, (Pakistan) | Hiatt | Unspecified | – | 0/11 (0) | 0/11 (0) | 0/11 (0) | 1.00 (0.88 to 1.14) | 19 |
Wang et al. [40] | Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, (China) | Michels/Hiatt | HPB | 45 | 12/127 (9.4) | 10/127 (7.9) | 1/127 (0.8) | 0.96 (0.69 to 1.33) | 19 |
Giani et al. [41] | Division of Minimally–Invasive Surgical Oncology, Grande Ospedale Metropolitano Niguarda, Milan, Italy | Michels | P | 13 | 0/14 (0) | 0/14 (0) | 0/14 (0) | 1.01 (0.51 to 1.97) | 20 |
Mangieri et al. [42] | Department of Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, NC (USA) | Unstandardized | P | – | 0/36 (0) | 0/36 (0) | 0/36 (0) | 0.73 (0.60 to 0.88) | 18 |
Pyras et al. [3] | Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, (Germany) | Hiatt | P | 47 | 0/80 (0) | 0/80 (0) | 0/80 (0) | 1.27 (0.89 to 1.81) | 20 |
Synthesis of results
Critical endpoints
Outcomes of interest | No. of studies | Event rate (%) or mean (SD) | RR/SMD/HR (95% CI) | P-value | ASS | RIS | C-Q, I2 (%) | P-value for reporting bias ^ | ||
---|---|---|---|---|---|---|---|---|---|---|
na-RHA arm | a-RHA arm | Egger | Begg | |||||||
Critical endpoint | ||||||||||
R1 | 15 | 346/1495 (23.1) | 81/422 (19.1) | 1.06 (0.89 to 1.27) | 0.494 | 2,592 | 74,354 | 0.216; 21 | 0.429 | 0.102 |
OS | 8 | – | – | 0.95 (0.85 to 1.06) | 0.348 | – | – | 0.102; 41 | 0.052 | 1.000 |
Morbidity | 15 | 946/2361 (40) | 278/699 (39.7) | 0.96 (0.88 to 1.06) | 0.434 | 3,060 | 219,696 | 0.313; 12 | 0.172 | 0.586 |
Mortality | 18 | 99/2903 (3.4) | 31/814 (3.8) | 0.81 (0.54 to 1.20) | 0.289 | 3,614 | 20,117 | 0.989; 0 | 0.835 | 1.000 |
Biliary fistula | 11 | 107/2285 (4.7) | 24/618 (3.9) | 1.09 (0.72 to 1.66) | 0.681 | 2,501 | 43,025 | 0.960;0 | 0.329 | 0.531 |
Secondary endpoints | ||||||||||
CR-POPF | 15 | 481/2774 (17.3) | 121/734 (16.4) | 1.10 (0.93 to 1.30) | 0.249 | 3,508 | 15,688 | 0.985; 0 | 0.508 | 0.151 |
PPH | 13 | 167/2555 (6.5) | 43/676 (6.4) | 1.00 (0.72 to 1.38) | 0.989 | 3,231 | 26,248 | 0.998; 0 | 0.069 | 0.272 |
DGE | 14 | 503/2716 (18.5) | 147/723 (20.3) | 0.84 (0.55 to 1.27) | 0.407 | 3,439 | 25,904 | 0.003;58 | 0.081 | 0.352 |
LOS | 11 | 16 ± 10 | 16 ± 9 | 0.80 (−0.70 to 2.38) | 0.325 | 2,840 | 77,351 | < 0.001;84 | 0.519 | 0.697 |
Operative time | 13 | 323 ± 58 | 324 ± 61 | −11.25 (−26.84 to 4.34) | 0.157 | 3,059 | 26,807 | < 0.001;95 | 0.086 | 0.272 |