Background and Aims: Distal pancreatectomy with en bloc celiac axis resection (DP-CAR), a complex surgery, has many potential advantages over the conventional distal pancreatectomy (DP) in the treatment of locally advanced pancreatic body/tail cancer, such as increasing R0 resection rate, reducing pain, improving quality of life, and prolonging survival. However, the clinical efficacy and safety of DP-CAR remain controversial. The purpose of this Meta-analysis was to evaluate the clinical efficacy and safety of DP-CAR in the treatment of locally advanced pancreatic body/tail cancer.
Methods: Literature searches, in both Chinese and English, were performed in several national and international databases from their inception to June 2019 by using relevant search terms. After literature screening strictly according to the inclusion and exclusion criteria, study data extraction and quality assessment of the included studies, Meta-analysis was conducted by RevMan 5.3 software.
Results: A total 13 studies were finally selected, all of which were non-randomized controlled studies, including one prospective study, and 12 retrospective studies; 2 multi-center studies and 11 single-center studies. A total of 
1 219 patients were involved, with 237 cases in the DP-CAR group and 982 cases in DP group. The results of Meta-analysis showed that there were no significant differences between DP-CAR group and DP group in 1-, 2- and 3-year survival rates (RR=0.86, 95% CI=0.63–1.18, P=0.36; RR=0.70, 95% CI=0.45–1.10, P=0.12; RR=0.93, 95% CI=0.51–1.70, P=0.82) as well as the incidence of postoperative pancreatic fistula (RR=1.12, 95% CI= 0.92–1.36, P=0.27), while the R0 resection rate was lower (RR=0.78, 95% CI=0.68–0.90, P=0.000 6) and the incidence rates of early postoperative death (RR=4.91, 95% CI=1.90–12.67, P=0.001), reoperation (RR=10.96, 95% CI=3.27–36.74, P=0.000 1), clinically relevant pancreatic fistula (RR=1.57, 95% CI=1.19–2.08, P=0.002) and delayed gastric emptying (RR=2.78, 95% CI=1.33–5.81, P=0.007) were significantly higher in DP-CAR group than those in DP group, further, the operative time was longer (MD=91.98, 95% CI=60.63–123.34, P<0.000 01) and estimated blood loss was greater (MD=275.33, 95% CI=135.95–414.71, P=0.000 1) in DP-CAR group than those in DP group.
Conclusion: DP-CAR offers no significant survival benefit for patients with locally advanced pancreatic body/tail cancer, in addition, it will increase the mortality and reoperation rates as well as the incidence of postoperative complication. So, this procedure should be chosen with caution.