Hybrid Laparoscopic Versus Open Pancreatoduodenectomy. A Meta‐Analysis

Abstract

Introduction Hybrid laparoscopic techniques have been proposed as a good transition from open to complete minimally invasive approach especially in complex surgical procedures. This meta-analysis aimed to compare the outcomes of hybrid laparoscopic pancreatoduodenectomy versus open pancreatoduodenectomy. Methods A systematic literature research was performed according to PRISMA guidelines. A broad search strategy with terms “laparoscopy” and “pancreatoduodenectomy” was used. Included studies were analyzed by quantitative meta-analysis using the metafor package for R software. Results Of 655 identified articles, 627 were excluded and 28 articles fully assessed, including 14 comparative studies, 8 case series and 6 case reports. Extracted data included intraoperative variables and postoperative outcome parameters. The predefined inclusion criteria were met by 14 comparative studies, and 371 patients were pooled in the meta-analysis. Hybrid laparoscopic pacreatoduodenectomy was associated with significantly longer operative time (I2 0%, p = 0,01, Mean HPD 494,6 min, Mean OPD 421,6 min, WMD 67 min, 95% CI 14–120 min). For all other postoperative outcome parameters, no statistically significant differences were found. A nonsignificant reduction in intraoperative transfusion rate (I2 20%, p = 0,2, proportion HPD 2%, proportion OPD 1,6%, OR 0,44, 95% CI 0,16–1,27) and blood loss (I2 95%, p = 0,1, Mean HPD 397,2 ml, Mean OPD 1017,8 ml, MD − 601 ml, 95% CI − 1311–108) was observed for hybrid pancreatoduodenectomy in comparison to open surgery. Conclusions This meta-analysis demonstrates significantly increased operation time for hybrid laparoscopic compared to open pancreatoduodenectomy. Intraoperative variables as well as postoperative parameters and major morbidity were comparable for both techniques. Overall results of this meta-analysis demonstrated the hybrid technique as a safe procedure in high-volume centers offering aspects of a safe transition to fully laparoscopic pancreatoduodenectomy.

Comparison of short-term outcomes of open and laparoscopic assisted pancreaticoduodenectomy for periampullary carcinoma: A propensity score-matched analysis

“…Previous meta-analyses of comparative studies have consistently demonstrated satisfactory oncologic outcomes, such as R0/R1 resection rates and lymph node yield, following LAPD compared to OPD in patients with malignant conditions [ 43 ]. In terms of oncological outcomes, our study found no statistically significant differences in tumor grade, the number of harvested lymph nodes, or margin status, which aligns with the findings of previous studies [ 43 ].…”

“…Previous meta-analyses of comparative studies have consistently demonstrated satisfactory oncologic outcomes, such as R0/R1 resection rates and lymph node yield, following LAPD compared to OPD in patients with malignant conditions [ 43 ]. In terms of oncological outcomes, our study found no statistically significant differences in tumor grade, the number of harvested lymph nodes, or margin status, which aligns with the findings of previous studies [ 43 ]. R0 resection, particularly at critical margins like the retroperitoneal margin and superior mesenteric artery margin, along with a favorable lymph nodal status, are considered the most crucial prognostic factors following PD.…”

Evolution of laparoscopic pancreaticoduodenectomy at Westmead Hospital

“…10 While HLPD was associated with significantly longer operating times, it was found to have comparable postoperative outcomes compared to OPD. 17,18 We also emphasize that LPD in this series have been performed in carefully selected patients according to our protocol and the majority of PD are performed via the open approach in our unit.…”

Pancreatoduodenectomía laparoscópica híbrida: resultado en paciente obeso con adenocarcinoma duodenal

“…Permite la resección venosa porto-mesentérica, sin perder el beneficio de la mínima invasión; y 6. Disminuye las complicaciones de la reconstrucción laparoscópica (2)(3)(4)6) . La indicación de PDL empezó restringida para casos muy seleccionados portadores de lesiones pequeñas benignas, premalignas o de bajo potencial maligno, como los quistes pancreáticos o los tumores neuroendocrinos.…”

“…La indicación de PDL empezó restringida para casos muy seleccionados portadores de lesiones pequeñas benignas, premalignas o de bajo potencial maligno, como los quistes pancreáticos o los tumores neuroendocrinos. La PDL y PDH han mostrado supervivencias a largo plazo similares a la PDA en neoplasias malignas del páncreas y peri ampulares (6,7) .…”