This meta-analysis suggests that the most effective treatment for reconstruction of pancreatic continuity after pancreatoduodenectomy is pancreaticogastrostomy. However, the advantage of the latter could potentially be demonstrated through further RCTs, including only patients at high risk of developing pancreatic fistulas.
In aggressive PMP, cytoreduction with peritonectomy procedure plus HIPEC is a safe procedure that suggests an improvement to the survival rates. Because optimal cytoreduction is a primary prognostic factor for survival rates, this procedure would have to be performed in an experienced center with a low morbidity. Neoadjuvant chemotherapy has not demonstrated benefits in these patients and further research will be required.
In pancreatic surgery, there is an increasing interest in the feasibility of minimal access techniques. Robotic surgery has improved some limitations of standard laparoscopy and it is expected as a promising access. We provide a comparative review between laparoscopic and robotic pancreaticoduodenectomies. Between 1996 and 2013, we found 284 patients in the laparoscopic group and 147 in the robotic. Operative time, morbidity, and mortality were similar for both the groups (425.94 min, 30.28%, 2.19% in the laparoscopic group and 415.88 min, 36.78%, and 2.72% for the robotic arm, respectively). The mean hospital stay, mean estimated blood loss, fistula, and conversion rates were 11.09 days, 172,93 mL, 13.02%, and 5.63% and 13.84 days, 346.44 mL, 27.69%, and 11.56% for the laparoscopic and robotic group, respectively (P<0.05). Laparoscopic pancreaticoduodenectomy may confer benefits over robotic pancreaticoduodenectomies, although it is expected that outcomes of both modalities are likely to improve with greater experience and better patient selection.
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