The oncological safety in minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis

Abstract

The safety of minimally invasive distal pancreatectomy (MIDP) and open distal pancreatectomy (ODP) regarding oncological outcomes of pancreatic ductal adenocarcinoma (PDAC) remains inconclusive. Therefore, the aim of this study was to examine the oncological safety of MIDP and ODP for PDAC. Major databases including PubMed, Embase, Science Citation Index Expanded, and the Cochrane Library were searched for studies comparing outcomes in patients undergoing MIDP and ODP for PDAC from January 1994 to August 2018. In total, 11 retrospective comparative studies with 4829 patients (MIDP: 1076, ODP: 3753) were included. The primary outcome was long-term survival, including 3-year overall survival (OS) and 5-year OS. The 3-year OS (hazard ratio (HR): 1.03, 95% confidence interval (CI): 0.89, 1.21; P = 0.66) and 5-year OS (HR: 0.91, 95% CI: 0.65, 1.28; P = 0.59) showed no significant differences between the two groups. Furthermore, the positive surgical margin rate (weighted mean difference (WMD): 0.71, 95% CI: 0.56, 0.89, P = 0.003) was lower in the MIDP group. However, patients in the MIDP group had less intraoperative blood loss (WMD: −250.03, 95% CI: −359.68, −140.39; P < 0.00001), a shorter hospital stay (WMD: −2.76, 95% CI: −3.73, −1.78; P < 0.00001) and lower morbidity (OR: 0.57, 95% CI: 0.46, 0.71; P < 0.00001) and mortality (OR: 0.50, 95% CI: 0.31, 0.81, P = 0.005) than patients in the ODP group. The limited evidence suggested that MIDP might be safer with regard to oncological outcomes in PDAC patients. Therefore, future high-quality studies are needed to examine the oncological safety of MIDP.

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

“…This study clari ed that LRAMPS is technically safe and feasible procedure in well-selected patients with PC in the distal pancreas. [19].Our series with 10 cases showed a morbidity rate of 50.0%, and the PF rate of 30.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].Even the operation more complicated, the LRAMPS didn't increase the risk of complications but with the advantages related to minimal-access surgery, such as less intraoperative blood loss, faster recovery. [19].…”

“…[19].Our series with 10 cases showed a morbidity rate of 50.0%, and the PF rate of 30.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].Even the operation more complicated, the LRAMPS didn't increase the risk of complications but with the advantages related to minimal-access surgery, such as less intraoperative blood loss, faster recovery. [19]. Our series with 10 cases showed a count of retrieved lymph nodes of 15 (range, [13][14][15][16][17][18][19][20][21],and the R0 resection rate of 100.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].So whether LRAMPS could achieve better oncological outcomes than laparoscopic conventional DPS or similar oncological outcomes as open RAMPS need more randomized controlled test to con rm.…”

“…[19]. Our series with 10 cases showed a count of retrieved lymph nodes of 15 (range, [13][14][15][16][17][18][19][20][21],and the R0 resection rate of 100.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].So whether LRAMPS could achieve better oncological outcomes than laparoscopic conventional DPS or similar oncological outcomes as open RAMPS need more randomized controlled test to con rm. No study to date has shown improved overall survival between RAMPS and standard DP [21][22][23].…”

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

“…The morbidity rates of LRAMPS reported in literatures varied greatly from 13.3-66.7% ( [6]. The morbidity rates and PF rates of laparoscopic conventional radical distal pancreatectomy for PC reported in literatures varied greatly from 13.6-52.9% [19].Our series with 10 cases showed a morbidity rate of 50.0%, and the PF rate of 30.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].Even the operation more complicated, the LRAMPS didn't increase the risk of complications but with the advantages related to minimal-access surgery, such as less intraoperative blood loss, faster recovery. [19].…”

“…The morbidity rates and PF rates of laparoscopic conventional radical distal pancreatectomy for PC reported in literatures varied greatly from 13.6-52.9% [19].Our series with 10 cases showed a morbidity rate of 50.0%, and the PF rate of 30.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].Even the operation more complicated, the LRAMPS didn't increase the risk of complications but with the advantages related to minimal-access surgery, such as less intraoperative blood loss, faster recovery. [19]. Our series with 10 cases showed a count of retrieved lymph nodes of 15 (range, [13][14][15][16][17][18][19][20][21],and the R0 resection rate of 100.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].So whether LRAMPS could achieve better oncological outcomes than laparoscopic conventional DPS or similar…”