Abstract:

Objective

To evaluate the significance and clinical application of Heidelberg triangle dissection in surgical treatment of pancreatic cancer by systematic review.

Methods

In April 2024， literature review was conducted from PubMed， Web of Science， Elsevier Journals， CNKI， Chongqing VIP and Wanfang databases using the key words: （“pancreatic cancer” OR “pancreatic neoplasm”） AND（“triangle” OR “Heidelberg technique” OR “Heidelberg triangle”） in English databases， and the key words:“ pancreatic cancer” OR “pancreatic neoplasm” AND “triangle”） in Chinese databases. The search results were limited to human research and articles in Chinese and English. Two authors independently reviewed and screened the literature. The quality of literatures was assessed by the Newcastle-Ottawa Scale （NOS）.

Results

2 152 studies were retrieved， and 4 retrospective cohort studies were finally included in the systematic review. The NOS scores of the included studies were ranged from 6 to 8. 525 patients were included in this study， including 327 cases of pancreaticoduodenectomy （PD） cohorts， 114 cases of total pancreatectomy （TP） cohorts and 84 cases of laparoscopic pancreaticoduodenectomy （LPD）. In the PD cohorts，the operation time in the Heidelberg tringle dissection group was （556±46） min， significantly longer than（501±61） min in the standard group （t=3.62， P＜0.05）. The median survival time after surgery was 21 months，significantly longer than 15 months in the standard group （χ²=4.30， P＜0.05）. The 3-year tumor recurrence rate was 55.56%， significantly lower than 83.33% in the standard group （P=0.040）. In the TP cohorts， the operation time in the Heidelberg tringle dissection group was 434（385，490） min， significantly longer than 367（315，445） min in the standard group （P=0.0002）. Intraoperative blood loss was 1 650（1 150，2 550） ml，significantly more than 800（500，1500） ml in the standard group （P＜0.0001）. The R0 resection rate was 30.8%， significantly higher than 10.5% in the standard group （P=0.0475）. In the LPD cohorts， the number of dissected lymph nodes in the Heidelberg tringle dissection group was 11.31±2.46， significantly more than 9.49±2.28 in the standard group （t=3.51， P＜0.05）. The R0 resection rate was 76.92%， significantly higher than 53.33% in the standard group （χ²=5.06， P=0.024）.

Conclusions

Heidelberg triangle dissection is safe and feasible in the surgical resection of pancreatic cancer， which can effectively reduce postoperative tumor recurrence rate and prolong the survival time of patients.

Key words: Pancreatic cancer, Heidelberg triangle, Pancreaticoduodenectomy, Total pancreatectomy, Prognosis, Systematic review