Periarterial Divestment in Locally Advanced Pancreatic Cancer: Systematic Review and Single-Arm Meta-Analysis

Abstract

Background:

Periarterial divestment has emerged as an artery-preserving alternative to formal arterial resection for borderline resectable and locally advanced pancreatic cancer. However, the available evidence remains limited. This study aimed to evaluate the perioperative and oncologic outcomes of periarterial divestment in pancreatic cancer.

Methods:

A systematic review was conducted using PubMed, Scopus, Web of Science, and the Cochrane Central Register to identify studies’ data published up to March 2026. Continuous outcomes were pooled as means with 95% confidence intervals (CIs), and binary outcomes were pooled as proportions using random-effects models. Heterogeneity was assessed using the I² statistic and the Cochrane Q test. Sensitivity analyses were performed using leave-one-out methods. All analyses were conducted in R version 4.4.2.

Results:

Five retrospective observational studies comprising 474 patients were included, of whom 92.8% had locally advanced pancreatic cancer and 64.8% received neoadjuvant therapy. The pooled operative time was 333.0 minutes (95% CI: 232.6–433.4; I² = 99%), estimated blood loss was 620.6 mL (95% CI: 292.4–948.7; I² = 97%), and length of hospital stay was 12.4 days (95% CI: 9.1–15.6; I² = 99%). The pooled incidence of intraabdominal infection, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, reoperation, major complications (Clavien–Dindo grade ≥ III), and 90-day mortality was 10.57%, 8.72%, 8.56%, 14.13%, 3.36%, 11.27%, and 4.18%, respectively. The pooled rates of venous resection, arterial resection, and R0 resection were 36.18%, 3.56%, and 43.33%, respectively. The pooled 1-year and 3-year disease-free survival rates were 50.42% and 17.77%, respectively, while the corresponding overall survival rates were 75.99% and 29.11%.

Conclusion:

Periarterial divestment has been applied in selected patients, with reported perioperative and oncologic outcomes across studies. However, the current evidence remains descriptive and does not allow comparative inference.