Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

Abstract

ObjectiveThis meta-analysis compares the perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to those of open pancreaticoduodenectomy (OPD) for pancreatic and periampullary tumors.BackgroundLPD has been increasingly applied in the treatment of pancreatic and periampullary tumors. However, the perioperative outcomes of LPD versus OPD are still controversial.MethodsPubMed, Web of Science, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials (RCTs) and non-randomized comparative trials (NRCTs) comparing LPD versus OPD for pancreatic and periampullary tumors. The main outcomes were mortality, morbidity, serious complications, and hospital stay. The secondary outcomes were operative time, blood loss, transfusion, postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), bile leak (BL), delayed gastric emptying (DGE), lymph nodes harvested, R0 resection, reoperation, and readmission. RCTs were evaluated by the Cochrane risk-of-bias tool. NRCTs were assessed using a modified tool from the Methodological Index for Non-randomized Studies. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42022338832).ResultsFour RCTs and 35 NRCTs concerning a total of 40,230 patients (4,262 LPD and 35,968 OPD) were included. Meta-analyses showed no significant differences in mortality (OR 0.91, p = 0.35), serious complications (OR 0.97, p = 0.74), POPF (OR 0.93, p = 0.29), PPH (OR 1.10, p = 0.42), BL (OR 1.28, p = 0.22), harvested lymph nodes (MD 0.66, p = 0.09), reoperation (OR 1.10, p = 0.41), and readmission (OR 0.95, p = 0.46) between LPD and OPD. Operative time was significantly longer for LPD (MD 85.59 min, p < 0.00001), whereas overall morbidity (OR 0.80, p < 0.00001), hospital stay (MD −2.32 days, p < 0.00001), blood loss (MD −173.84 ml, p < 0.00001), transfusion (OR 0.62, p = 0.0002), and DGE (OR 0.78, p = 0.002) were reduced for LPD. The R0 rate was higher for LPD (OR 1.25, p = 0.001).ConclusionsLPD is associated with non-inferior short-term surgical outcomes and oncologic adequacy compared to OPD when performed by experienced surgeons at large centers. LPD may result in reduced overall morbidity, blood loss, transfusion, and DGE, but longer operative time. Further RCTs should address the potential advantages of LPD over OPD.Systematic review registrationPROSPERO, identifier CRD42022338832.

Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: A systematic review and meta-analysis

“…In addition, the lower serious postoperative complications and conversion rate in RMH group became no significant when analyzed studies of single centre. Given the detection power of sample size, so some outcomes studied such as postoperative morbidity and conversion rate may also have been influenced by sample size issues 55 . It suggested that some of the current studies may be underpowered for comparing complex surgical approaches, and further randomized trials with larger numbers of participants are indispensable to clarify surgical outcomes between RMH and LMH with adequate statistical power.…”

Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for carcinoma of the ampulla of Vater in a medium-volume center: a propensity score matching analysis

“… 3 , 4 Recently, there have been numerous studies of the efficacy of LPD, and its advantages, such as less intraoperative bleeding and shorter hospital stay, have been confirmed. 7 – 9 , 22 – 24 However, the safety and postoperative survival rate of LPD remain controversial. The LEOPARD-2 trial reported a higher 90-day complication-related death rate in the LPD vs OPD groups, 25 while another multicenter randomized controlled trial confirmed that LPD was safe and effective in patients with pancreatic or periampullary tumors when performed by experienced pancreatic surgeons.…”

“…Furthermore, the prognosis of patients in the LPD group was not inferior to that of the OPD group, in our study, and the results were similar to those reported by large-volume centers in Japan and internationally. 8 , 9 , 24 , 26 , 28 , 36 , 43 , 44 However, the gap between large- and moderate-volume centers mainly involves lymph node dissection and postoperative complication rates. The reasons for these differences are as follows: First, patients who undergo LPD are usually in the early stage of the disease, and the degree of differentiation is mainly high or moderate.…”

“… 6 Most studies have shown that the rates of major complications and short-term survival are similar after the two types of surgery. 7 However, the study populations in recent studies were mainly concentrated in large-volume centers, 8 , 9 and confounding factors and selection bias between groups were not well-controlled. Few such studies have been performed in medium-volume centers with acceptable technical conditions.…”

The Role of C-reactive Protein and Procalcitonin in Predicting the Occurrence of Pancreatic Fistula in Patients who Underwent Laparoscopic Pancreaticoduodenectomy: a Retrospective Study

“…Laparoscopic pancreaticoduodenectomy (LPD) is one of the complex operations that has long posed a challenge to surgeons because of its difficulty and the high level of expertise and precision required. Since Dr. Gagner's first case was published in 1994 [1], a series of technical development processes have emerged [2], which have made this surgical procedure more accurate and safer, with fewer complications [3,4], and as a result, the rates of performing this surgical procedure have increased rapidly around the world. Postoperative complications have always been a source of concern for doctors because pancreatic surgery is a major and challenging surgical procedure for both the patient and the physician.…”