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

Abstract

BackgroundTo compare perioperative and oncological outcomes of pancreatic duct adenocarcinoma (PDAC) after laparoscopic versus open pancreaticoduodenectomy (LPD vs. OPD), we performed a meta-analysis of currently available propensity score matching studies and large-scale retrospective cohorts to compare the safety and overall effect of LPD to OPD for patients with PDAC.MethodsA meta-analysis was registered at PROSPERO and the registration number is CRD42021250395. PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Data on operative times, blood loss, 30-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien–Dindo ≥3 complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, overall survival, and long-term survival) were subjected to meta-analysis.ResultsOverall, we identified 10 retrospective studies enrolling a total of 11,535 patients (1,514 and 10,021 patients underwent LPD and OPD, respectively). The present meta-analysis showed that there were no significant differences in overall survival time, 1-year survival, 2-year survival, 30-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, and lymph node dissection between the LPD and OPD groups. Nevertheless, compared with the OPD group, LPD resulted in significantly higher rate of R0 resection (OR: 1.22; 95% CI 1.06–1.40; p = 0.005), longer operative time (WMD: 60.01 min; 95% CI 23.23–96.79; p = 0.001), lower Clavien–Dindo grade ≥III rate (p = 0.02), less blood loss (WMD: −96.49 ml; 95% CI −165.14 to −27.83; p = 0.006), lower overall morbidity rate (OR: 0.65; 95% CI 0.50 to 0.85; p = 0.002), shorter LOS (MD = −2.73; 95% CI −4.44 to −1.03; p = 0.002), higher 4-year survival time (p = 0.04), 5-year survival time (p = 0.001), and earlier time to starting adjuvant chemotherapy after surgery (OR: −10.86; 95% CI −19.42 to −2.30; p = 0.01).ConclusionsLPD is a safe and feasible alternative to OPD for patients with PDAC, and compared with OPD, LPD seemed to provide a similar OS.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Chinese expert consensus on minimally invasive radical surgery for pancreatic ductal adenocarcinoma (version 2022)

“…Although LPD had slightly longer operative time than open pancreatoduodenectomy (OPD), [3][4][5] -related meta-analyses showed that LPD was significantly better in hospital stay and intraoperative blood loss for PDAC patients. There were no statistical differences in postoperative pancreatic fistula, postoperative hemorrhage, and perioperative mortality between LPD and OPD for PDAC.…”

“…[9] However, no statistical difference was found in overall survival (OS). [4][5][6]10] Chapman et al analyzed data from the NCDB and found that LPD patients aged ≥75 years had significantly longer OS compared with OPD. [8] In addition, after adjusting for patient and tumor-related characteristics, there was a trend toward improved OS in the LPD group.…”

“…[4] However, another meta-analysis found no statistically significant differences in the R0 resection rate and the number of harvested lymph nodes between LPD and OPD. [9] Both Feng et al and Peng et al reported that LPD resulted in an earlier time to start adjuvant chemotherapy after surgery compared with OPD, [5,10] while Chen et al found no statistical difference. [9] No statistical difference was found in the rate of adjuvant chemotherapy between LPD and OPD.…”

“…There were no statistical differences in postoperative pancreatic fistula, postoperative hemorrhage, and perioperative mortality between LPD and OPD for PDAC. [5,6] Cai et al reported that LPD could be applied safely to elderly PDAC patients aged ≥70 years despite their poorer nutritional conditioning and larger frequency of comorbidities than younger patients. [7] Chapman et al identified PDAC patients aged ≥75 years who underwent LPD or OPD from the National Cancer Database (NCDB) and found that 90-day mortality was significantly lower in the LPD group compared with the OPD.…”

“…Both Feng et al and Peng et al reported that LPD resulted in an earlier time to start adjuvant chemotherapy after surgery compared with OPD, [5,10] while Chen et al found no statistical difference. [9] No statistical difference was found in the rate of adjuvant chemotherapy between LPD and OPD.…”