Perioperative and oncological outcomes following minimally invasive versus open pancreaticoduodenectomy for pancreatic duct adenocarcinoma

Abstract

Background The outcomes of minimally invasive pancreaticoduodenectomy have not been adequately compared with those of open pancreaticoduodenectomy in patients with pancreatic ductal adenocarcinoma. We performed a meta‐analysis to compare the perioperative and oncological outcomes of these two pancreaticoduodenectomy procedures specifically in patients with pancreatic ductal adenocarcinoma. Methods Before this study was initiated, a specific protocol was designed and has been registered in PROSEPRO (ID: CRD42020149438). Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, PubMed, EMBASE, Web of Science, Cochrane Central Register, and ClinicalTrials.gov databases were systematically searched for studies published between January 1994 and October 2019. Overall survival, disease-free survival, and time to commencing adjuvant chemotherapy were the primary endpoint measurements, whereas perioperative and short-term outcomes were the secondary endpoints. Results The final analysis included 9 retrospective cohorts comprising 11,242 patients (1377 who underwent minimally invasive pancreaticoduodenectomy and 9865 who underwent open pancreaticoduodenectomy). There were no significant differences in the patients’ overall survival, operative time, postoperative complications, 30-day mortality, rate of vein resection, number of harvested lymph nodes, or rate of positive lymph nodes between the two approaches. However, disease-free survival, time to starting adjuvant chemotherapy, length of hospital stay, and rate of negative margins in patients who underwent minimally invasive pancreaticoduodenectomy showed improvements relative to those in patients who underwent open surgery. Conclusions Minimally invasive pancreaticoduodenectomy provides similar or even improved perioperative, short-term, and long-term oncological outcomes when compared with open pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma.

Laparoscopic Pancreaticoduodenectomy Versus Conventional Open Approach for Patients With Pancreatic Duct Adenocarcinoma: An Up-to-Date Systematic Review and Meta-Analysis

“…They found that LPD was associated with longer 3-year survival, 4-year survival, and 5-year survival time, and there was no difference in 1-year survival, 2-year survival time, lymph nodes harvested, the number of positive lymph nodes, and R0 rate. The meta-analysis of Yin et al ( 9 ) covered 9,144 PDAC participants from six retrospective studies, and the meta-analysis of Sun et al ( 8 ) covered 1,377 minimally invasive pancreaticoduodenectomy (LPD and RPD) and 9,865 OPD from nine retrospective studies. They advised that LPD was associated with higher R0 rate, longer operative time, fewer blood loss, lower transfusion rate, and shorter length of hospital stay.…”

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

“…Regarding the effect of minimally invasive PD on DGE development, the findings are inconclusive. National registries [ 37 ] and meta-analyses [ 38 , 39 ] were not able to detect an effect, single-center studies showed different results ( 40 , 41 ). Robotic PD was introduced in our department several years ago, but because its use does not span the whole period, we did not include minimally invasive PD into our analysis.…”

ROBOT‐assisted pancreatoduodenectomy in 300 consecutive cases: Annual trend analysis and propensity score‐matched comparison of perioperative and long‐term oncologic outcomes with the open method

“…Moreover, among these, one study focused on vessel resection; therefore, survival comparison between RAPD and open PD was not performed 13 . For patients with PDAC, a recently published meta‐analysis comparing minimally invasive PD and open PD included only one study of RAPD 14,15 . Moreover, this study included only 19 patients with PDAC in RAPD compared to open PD patients 14 .…”