Does Minimally-Invasive Pancreaticoduodenectomy Have Advantages over Its Open Method? A Meta-Analysis of Retrospective Studies

Abstract

BackgroundWhile more and more open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Therefore, we carried out this meta-analysis to evaluate whether MIPD is safe, feasible and worthwhile.MethodsPubMed, EMBASE, and Cochrane Library were searched to identify studies published between January 1994 and November 2013 comparing MIPD with open pancreaticoduodenectomy (OPD). Intraoperative outcomes, oncologic safety, postoperative complications, and postoperative recovery were evaluated.Results11 retrospective studies representing 869 patients (327 MIPDs, 542 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (MD −361.93 ml, 95% CI −519.22 to −204.63 ml, p<0.001, I2 = 94%), wound infection (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007, I2 = 0%), and hospital stay (MD −2.64 d, 95% CI −4.23 to −1.05 d, p = 0.001, I2 = 78%). However, it brings longer operative time (MD 105 min, 95% CI 49.73 to 160.26 min, p<0.001, I2 = 93%). There were no significant differences between the two procedures in likelihood of overall complications (p = 0.05), pancreatic fistula (PF) (p = 0.86), delayed gastric empting (DGE) (p = 0.96), positive surgical margins (p = 0.07), retrieval of lymph nodes (p = 0.48), reoperation (p = 0.16) and mortality (p = 0.64).ConclusionsOur results suggest that MIPD is currently safe, feasible and worthwhile. But considering the selection bias, complexity of MIPD and lack of long-term oncologic outcomes, we suggest it be performed in a high-volume pancreatic surgery center in selected patients.

Laparoscopic pancreaticoduodenectomy; Single-surgeon experience

“…[15] Therefore, some authors suggest that it should be performed in highvolume pancreatic surgery centers in selected patients. [16] Recently, minimally invasive robotic pancreaticoduodenectomy emerged as a new technique. Despite its potential benefits and encouraging results, robotic pancreatico-duodenectomy use is limited and controversial.…”

Minimally invasive surgical treatment of carcinoma of the papilla of Vater: A case report

“…The post-operative course was apparently different from the course of conventional open surgical procedures, namely, by the reduced time of patient's recovery due to minimal trauma, and the reduced time to getting the patient to a vertical position. In addition, the time required for the recovery intestinal peristalsis and conversion to oral feeding and reduced use of analgesics were evidently different (10). A sufficient extent of surgical resection and lymphadenectomy can be achieved by laparoscopic access, as proved by the pathological examination of the resection specimen showing a sufficient number of lymph nodes resected and negative resection margins.…”

Minimally invasive pancreatic surgery—where are we going?

“…Systematic reviews and meta-analyses comparing MIPD and OPD report less intraoperative blood loss, a lower transfusion rate, longer operative time, and shorter hospital stay for the former [42][43][44][45]. The oncologic outcomes were equivalent to those in OPD [41,45].…”