Laparoscopic Versus Open Pancreatoduodenectomy in Patients With Periampullary Tumors

Abstract

Objective: To conduct a systematic review and meta-analysis of randomized controlled trials compared laparoscopic pancreatoduodenectomy (LPD) versus open pancreatoduodenectomy (OPD) in patients with periampullary tumors. Background: LPD has gained attention; however, its safety and efficacy versus OPD remain debatable. Methods: We searched PubMed and Embase. Primary outcomes were the length of hospital stay (LOS) (day), Clavien-Dindo grade ≥III complications, and 90-day mortality. Secondary outcomes were blood loss (milliliter), blood transfusion, duration of operation (minute), readmission, reoperation, comprehensive complication index score, bile leak, gastrojejunostomy or duodenojejunostomy leak, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, surgical site infection, intra-abdominal infection, number of harvested lymph nodes, and R0 resection. Pooled odds ratio (OR) or mean difference (MD) of data was calculated using the random-effect model. The grading of recommendations, assessment, development and evaluation approach was used for grading the level of evidence. Results: Four randomized controlled trials yielding 818 patients were included, of which 411 and 407 patients underwent LPD and OPD, respectively. The meta-analysis concluded that 2 approaches were similar, except in the LPD group, the LOS tended to be shorter [MD=−2.54 (−5.17, 0.09), P=0.06], LOS in ICU was shorter [MD=−1 (−1.8, −0.2), P=0.01], duration of operation was longer [MD=75.16 (23.29, 127.03), P=0.005], blood loss was lower [MD=−115.40 (−152.13, −78.68), P<0.00001], blood transfusion was lower [OR=0.66 (0.47, 0.92), P=0.01], and surgical site infection was lower [OR=0.35 (0.12, 0.96), P=0.04]. The overall certainty of the evidence was moderate. Conclusions: Within the hands of highly skilled surgeons in high-volume centers, LPD is feasible and as safe and efficient as OPD.

Impact of Unplanned Intra‐Operative Conversions on Outcomes in Minimally Invasive Pancreatoduodenectomy

“…In keeping with the IDEAL framework for surgical innovation, all novel interventions should preferably be evaluated against the current standard in a randomized controlled trial (RCT) [ 37 ]. And so, an updated meta-analysis of RCTs comparing LPD vs. open PD confirmed a significantly lower blood loss and surgical site infection rate in the LPD cohort, while the approaches were similar with respect to other outcomes [ 38 ]. The benefits of MIPD in terms of improvements in optics, surgical instrumentation, and increased access to training [ 12 , 39 ] have led to an increased interest amongst surgeons to attempt MIPD.…”

Extended pancreatic neck transection versus conventional pancreatic neck transection during laparoscopic pancreaticoduodenectomy (LPDEXCEPT): protocol for a multicentre superiority randomised controlled trial

“…All patients with an indication for elective LPD will be evaluated. The reasons for laparoscopic approach is the only choice for this trial but not open or robotic are as follows: there are many aspects that differ between open and minimally invasive (laparoscopic and robotic) pancreaticoduodenectomy, including some of the postoperative complications, duration of surgery, intraoperative bleeding, length of hospitalisation and so on 15–18. And it is still up for debate to choose the approach.…”

“…The reasons for laparoscopic approach is the only choice for this trial but not open or robotic are as follows: there are many aspects that differ between open and minimally invasive (laparoscopic and robotic) pancreaticoduodenectomy, including http://bmjopen.bmj.com/ some of the postoperative complications, duration of surgery, intraoperative bleeding, length of hospitalisation and so on. [15][16][17][18] And it is still up for debate to choose the approach. Studies would inevitably introduce additional confounding factors once multiple approaches are included.…”