Comparison of postoperative complications and long‐term oncological outcomes in minimally invasive versus open pancreatoduodenectomy for distal cholangiocarcinoma: A propensity score‐matched analysis

Kim, Sung Hyun; Lee, Boram; Hwang, Ho Kyoung; Lee, Jun Suh; Han, Ho‐Seong; Lee, Woo Jung; Yoon, Yoo-Seok

doi:10.1002/jhbp.1067

Cited by 9 publications

(6 citation statements)

References 34 publications

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“…Several studies have shown that LPD and OPD have similar long-term survival rates in the treatment of pancreatic and periampullary cancers (15,27). A recently published paper showed that there was no significant difference in long-term survival between LPD and OPD in DCC (30). In contrast, our research revealed that the prognosis for LPD was improved.…”

Section: Discussioncontrasting

confidence: 44%

Comparison of laparoscopic and open pancreaticoduodenectomy for the treatment of distal cholangiocarcinoma: A propensity score matching analysis

Zhu

Zu²,

Wu³

et al. 2022

Front. Oncol.

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BackgroundThere are few studies comparing the oncological outcomes of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for distal cholangiocarcinoma (DCC). Our objective was to assess the short-term efficacy and long-term survival of LPD and OPD in patients with DCC.MethodsThe data of 124 DCC patients who underwent LPD or OPD at the Third Affiliated Hospital of Soochow University from May 2010 to May 2021 were retrospectively analyzed. Propensity score matching was performed to balance the two groups of baseline characteristics. After 1:1 matching, the overall survival (OS) of the two groups was compared by the Kaplan−Meier method. Univariate and multivariate Cox regression analyses were used to identify independent predictors of OS.ResultsThe original cohort consisted of 124 patients. Nineteen patients were excluded because of incomplete baseline or follow-up data, and the remaining 105 patients were divided into two cohorts (45 in the LPD group and 60 in the OPD group). The LPD group showed more favorable results in OS analysis (LPD vs. OPD, 56.4 [46.2-66.5] vs. 48.9 [36.4-61.4], months, P=0. 01). PSM analysis identified 30 pairs of patients, and differences between matching groups were still significant (LPD vs. OPD, 67.9[58.2-77.6] vs. 47.4[31.4-67.5], months, P=0.002). Moreover, the LPD group experienced less intraoperative bleeding (LPD vs. OPD, 292.67 vs. 519.17 mL, P=0.002). Univariate analysis showed that surgical modality (P=0.012), carbohydrate antigen 19-9 (P=0.043), carcinoembryonic antigen (P=0.003), neutrophil-to-lymphocyte ratio (P=0.012), blood transfusion (P=0.031), clinically relevant postoperative pancreatic fistula (P<0.001) and lymphatic metastasis (P=0.004) were predictors of OS. Multivariate Cox analysis demonstrated that carbohydrate antigen 19-9 (P=0.048), carcinoembryonic antigen (P=0.031) and lymphatic metastasis (P=0.023) were independent predictive factors of OS. However, adjuvant therapy had no significant effect on the OS of DCC patients after radical pancreaticoduodenectomy (P>0.05).ConclusionsFor DCC patients, LPD may be a more recommended procedure because of its advantages over OPD in terms of intraoperative bleeding and long-term survival.

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Section: Discussioncontrasting

confidence: 44%

Comparison of laparoscopic and open pancreaticoduodenectomy for the treatment of distal cholangiocarcinoma: A propensity score matching analysis

Zhu

Zu²,

Wu³

et al. 2022

Front. Oncol.

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“…Effect sizes were presented as mean differences with a 95% CI. The random‐effects model was used for pooling analysis to compensate for the heterogeneity of studies [ 23 , 24 ] statistics. In this regard, I2 ≥ 50% and ≥75% indicated substantial and considerable heterogeneity [ 24 ] study removal method to the subanalysis to assess whether any individual study exerted particular influence on the overall effect size [ 25 , 26 ]; p‐values < 0.05 were considered statistically significant.…”

Section: Reviewmentioning

confidence: 99%

“…All three studies report similar findings regarding long-term outcomes. Uijterwijk et al [ 23 ] and Kim et al [ 24 ] suggest that MIPD is comparable to OPD in terms of long-term outcomes, while Xu et al [ 25 ] indicates no significant differences in long-term survival between RPD and OPD groups.…”

Section: Reviewmentioning

confidence: 99%

Comparative Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy in Distal Cholangiocarcinoma: A Systematic Review and Meta-Analysis

Domene,

Quiroz Flores,

Fulginiti

et al. 2024

Cureus

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Pancreatoduodenectomy, the primary surgical strategy for managing cholangiocarcinoma, is executed via two distinct methodologies, namely minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD). The selection between these surgical options is critical, as it directly influences patient outcomes, encompassing both short-term recovery metrics and long-term survival rates. Despite the clinical significance of these procedures, there exists a notable void in the literature regarding a comprehensive comparison of MIPD and OPD, particularly in assessing their respective efficacies and complications. This lack of detailed comparative analysis has left a gap in evidence-based guidance for clinicians faced with the decision of choosing the most appropriate surgical approach for their patients. The absence of robust data comparing the two techniques underscores the necessity for a meta-analysis that rigorously examines and contrasts the outcomes associated with MIPD and OPD. By drawing upon a wide array of international studies, this research aims to shed light on the advantages and potential drawbacks of each method, thereby providing a more informed basis for surgical decision-making in the treatment of cholangiocarcinoma.

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“…Based on the results, the criteria of MIPD have expanded and MIPD showed similar oncologic outcomes when compared with open PD. 5,6 Thus, MIPD was shown to be an acceptable procedure in terms of clinical and oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…These studies demonstrated the safety and feasibility of MIPD by comparing it with open pancreatoduodenectomy (PD). Based on the results, the criteria of MIPD have expanded and MIPD showed similar oncologic outcomes when compared with open PD 5,6 . Thus, MIPD was shown to be an acceptable procedure in terms of clinical and oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive pancreatoduodenectomy by junior surgeon: Initial experience of the next generation

Kim,

Hong,

Kang

2024

World j. surg.

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BackgroundSeveral guidelines exist for minimally invasive pancreatoduodenectomy (MIPD) regarding its prerequisites and learning curve. However, these guidelines are based on the experience of the pioneers of MIPD; minimal data exist on the experience of the next generation of surgeons. The aim of this study was to compare the two surgeon types (veteran and junior) for MIPD in terms of immediate postoperative outcomes.MethodsThe postoperative outcomes of 22 patients who underwent robot‐assisted pancreatoduodenectomy (RAPD) by a junior surgeon from July 2021 to December 2022 were retrospectively reviewed. The outcomes were compared with the initial postoperative outcomes and the contemporary postoperative outcomes of RAPD by a veteran surgeon.ResultsIn comparing the initial outcomes between the two surgeon types, the veteran surgeons showed a shorter operation time (junior surgeon vs. veteran surgeon: 606 ± 89 vs. 467 ± 77 min, p < 0.001). However, there was no significant difference in terms of postoperative outcomes, such as blood loss (300 [200–600] ml. vs. 200 [100–500] ml, p = 0.208), major complications (≥CDC IIIa: 4 (18.2%) vs. 4 (18.2%), p = 1.000), postoperative pancreatic fistula (POPF; ≥ISGPF Grade B: 2 (9.1%) vs. 3 (13.6%), p > 0.999), and length of hospital stay (18.0 ± 8.9 days vs. 18.3 ± 7.9 days, p = 0.915), between the two surgeon types. In addition, in a comparison of the contemporary outcomes, there was no significant difference in terms of postoperative outcome (complications: 4 (18.2%) vs 11 (11.1%), p = 0.580; POPF: 2 (9.1%) vs. 3 (3.0%), p = 0.484; length of hospital stay: 18.0 ± 8.9 vs. 15.0 ± 6.5 days, p = 0.065).ConclusionThe initial outcomes of MIPD by a well‐trained junior surgeon were found to be comparable to those of MIPD by a veteran surgeon.

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Comparison of postoperative complications and long‐term oncological outcomes in minimally invasive versus open pancreatoduodenectomy for distal cholangiocarcinoma: A propensity score‐matched analysis

Cited by 9 publications

References 34 publications

Comparison of laparoscopic and open pancreaticoduodenectomy for the treatment of distal cholangiocarcinoma: A propensity score matching analysis

Comparison of laparoscopic and open pancreaticoduodenectomy for the treatment of distal cholangiocarcinoma: A propensity score matching analysis

Comparative Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy in Distal Cholangiocarcinoma: A Systematic Review and Meta-Analysis

Minimally invasive pancreatoduodenectomy by junior surgeon: Initial experience of the next generation

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