Laparoscopic Versus Open Pancreaticoduodenectomy

Nickel, Felix; Haney, Caelán Max; Kowalewski, Karl‐Friedrich; Probst, Pascal; Limen, Eldridge Frederick; Kalkum, Eva; Diener, Marcus K; Strobel, Oliver; Müller‐Stich, Beat P.; Hackert, Thilo

doi:10.1097/sla.0000000000003309

Cited by 205 publications

(70 citation statements)

References 52 publications

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“…Surprisingly, the outcome we pooled was considerably longer than the former two. This difference could, in part, be caused by the different regulations and culture in different countries (6,52). Statistical analysis had been submitted at this point by Boggi with the result of 21.9 days in Europe, 13.0 days in Asia and 9.4 days in North America (6).…”

Section: Discussionmentioning

confidence: 99%

The state of minimally invasive pancreaticoduodenectomy in Chinese mainland: A systematic literature review

Ding

Zhang

Huang

et al. 2019

BST

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The development of Minimally invasive pancreaticoduodenectomy (MIPD) in Chinese mainland has been extremely quick. However, the safety and oncologic outcomes remain controversial. This review evaluates the current status of MIPD in Chinese mainland. A systematic literature search was performed using: Pubmed, Web of Sci, CNKI, Wanfang Data and Sinomed databases to filter all studies published up to and including June 2019 using key words "pancreaticoduodenectomy," or "Whipple operation" combined with "laparoscopy," or "laparoscopic," or "robotic," or "da Vinci," or "minimally invasive," or "hand-assisted". This systematic review included 39 articles that documented 2,653 MIPDs in Chinese mainland. The weighted average operative time was 370.6 min, and the weighted average blood loss was 278.0 mL. The overall morbidity was 31.9%, which Clavien-Dindo ≥ 3 complications accounted for 13.4%. Pancreatic fistula, delayed gastric emptying, bile leak and postoperative hemorrhage were reported in 20.9%, 5.5%, 3.5% and 6.0% of patients respectively. The average lengh of hospital stay was 16.1 days. The overall surgical mortality was 1.7%. The mean number of harvested lymph nodes was 13.5, and the rate of positive margin was 5.3%. Based on Chinese national condition, the operative volume of MIPD in Chinese mainland is the leading position in the world, and compared with some large international meta-analysis, no inferior perioperative and short-term oncological outcomes were observed in MIPD of Chinese mainland. However, research on survival analysis and phased learning curve outcomes is needed urgently before the innovative techniques are widely accepted.

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Section: Discussionmentioning

confidence: 99%

The state of minimally invasive pancreaticoduodenectomy in Chinese mainland: A systematic literature review

Ding

Zhang

Huang

et al. 2019

BST

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“…Retrospective studies showed comparable efficacy with reduced hospital stay and blood loss compared to open PD [94,95]. Nevertheless, recent published evidence failed to show the superiority or even equivalence of the laparoscopic approach to the Whipple procedure [96]. Indeed, a randomised controlled trial was stopped prematurely because of an excess of mortality in the laparoscopic group compared with the open approach [97].…”

Section: Discussionmentioning

confidence: 99%

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Heise

Ali

Hasenclever

et al. 2020

JCM

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Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8–81.4%, I2 = 91.38%) for EA, 96.4% (93.6–99.2%, I2 = 37.8%) for SA and 98.9% (98.0–99.7%, I2 = 0%) for PD. AEs were 24.7% (19.8–29.6%, I2 = 86.4%), 28.3% (19.0–37.7%, I2 = 76.8%) and 44.7% (37.9–51.4%, I2 = 0%), respectively. Recurrences were registered in 13.0% (10.2–15.6%, I2 = 91.3%), 9.4% (4.8–14%, I2 = 57.3%) and 14.2% (9.5–18.9%, I2 = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.

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“…The published evidence failed to show the superiority or even equivalence of the laparoscopic approach to the Whipple procedure [90]. Indeed, a randomised controlled trial was stopped prematurely because of an excess of mortality in the laparoscopic approach compared with the open approach [91].…”

Section: Surgical Approach: Minimally Invasive Versus Open Pancreatecmentioning

confidence: 99%

Surgical Management of Neuroendocrine Tumours of the Pancreas

Souche

Hobeika

Hain

et al. 2020

JCM

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Neuroendocrine tumours of the pancreas (pNET) are rare, accounting for 1–2% of all pancreatic neoplasms. They develop from pancreatic islet cells and cover a wide range of heterogeneous neoplasms. While most pNETs are sporadic, some are associated with genetic syndromes. Furthermore, some pNETs are ‘functioning’ when there is clinical hypersecretion of metabolically active peptides, whereas others are ‘non-functioning’. pNET can be diagnosed at a localised stage or a more advanced stage, including regional or distant metastasis (in 50% of cases) mainly located in the liver. While surgical resection is the cornerstone of the curative treatment of those patients, pNET management requires a multidisciplinary discussion between the oncologist, radiologist, pathologist, and surgeon. However, the scarcity of pNET patients constrains centralised management in high-volume centres to provide the best patient-tailored approach. Nonetheless, no treatment should be initiated without precise diagnosis and staging. In this review, the steps from the essential comprehensive preoperative evaluation of the best surgical approach (open versus laparoscopic, standard versus sparing parenchymal pancreatectomy, lymphadenectomy) according to pNET staging are analysed. Strategies to enhance the short- and long-term benefit/risk ratio in these particular patients are discussed.

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Laparoscopic Versus Open Pancreaticoduodenectomy

Cited by 205 publications

References 52 publications

The state of minimally invasive pancreaticoduodenectomy in Chinese mainland: A systematic literature review

The state of minimally invasive pancreaticoduodenectomy in Chinese mainland: A systematic literature review

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Surgical Management of Neuroendocrine Tumours of the Pancreas

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