Comparison of overall survival and perioperative outcomes of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis

Abstract

Background The aim of this study was to compare the oncological outcomes and clinical efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with pancreatic ductal adenocarcinoma (PDAC). Methods We systematically searched PubMed, EMBASE, Web of Science, ClinicalTrials.gov and the Cochrane Central Register for studies published between May 1998 and May 2018. The included studies compared LPD and OPD for the treatment of PDAC. The oncological outcomes and perioperative data were analyzed. Results Eight studies involving 15,278 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS) between patients undergoing the two types of surgery (HR: 0.97, 95% CI 0.82–1.15, p = 0.76). LPD resulted in a higher rate of R0 resection than OPD (OR: 1.16, 95% CI 0.85–1.57, p > 0.05). This study showed that compared with OPD, LPD resulted in comparable rates of postoperative pancreatic fistulas (POPFs) (OR: 1.07, 95% CI: 0.68–1.68, p = 0.77) and postoperative hemorrhage (OR: 1.74, 95% CI 0.96–3.71, p = 0.07), more harvested lymph nodes (WMD: 1.84, 95% CI: 0.95–2.72, p < 0.05), shorter hospital stays (WMD: -2.45, 95% CI: − 3.33- -1.56, p < 0.05), and less estimated blood loss (WMD: -374.30, 95% CI: − 513.06- -235.54, p < 0.05). Conclusions LPD is equivalent to OPD with respect to 5-year OS and results in better perioperative clinical outcomes for patients with PDAC.

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

“…[101][102][103] In a recent meta-analysis, a significantly higher R0 resection rate and a significantly higher number of lymph node dissections were reported for LPD; however, the 5-year survival rate for LPD was equivalent to that of OPD. 104 The postoperative mortality rate for LPD was higher in the low-volume center than in the high-volume center. 97,99,105,106 The complication rate was lower in the institution with MIPD >20 cases per year or PD >20 cases per year, 107 and it was also reported that the mortality rate was lower in the institution with PD >10 cases per year.…”

Systematic review and updated network meta-analysis comparing open, laparoscopic, and robotic pancreaticoduodenectomy

“…Previous studies have showed that LapPD and RobPD seem to be equally safe and were associated with reduced morbidity, shorter hospital length of stay, and non-inferior oncologic outcomes when compared to OpenPD [9][10][11][12][13][14]. The purpose of this network meta-analysis is to provide an updated evidence comparing short-term surgical and oncologic outcomes within pure OpenPD, LapPD, and RobPD.…”

Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma?

“…Recently, three meta-analyses have been published, comparing the oncologic outcomes of LPD and OPD. Jiang et al [ 81 ] systematically reviewed the articles comparing LPD and OPD for the treatment of pancreatic cancer. They found 8 studies involving 15,278 patients and performed meta-analysis.…”