Laparoscopic versus open pancreaticoduodenectomy for pancreatic neuroendocrine tumors: a single-center experience

Kim, Hanbaro; Song, Ki Byung; Hwang, Dae Wook; Lee, Jae Hoon; Alshammary, Shadi; Kim, Song Cheol

doi:10.1007/s00464-019-06969-7

Cited by 17 publications

(18 citation statements)

References 28 publications

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“…The literature search yielded 556 relevant English publications from various electronic databases. According to the inclusion criteria, 13 retrospective cohort studies and one RCT (5,7,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) comparing LPD and OPD in a total of 2,702 patients (1,040 and 1,662 underwent LPD and OPD, respectively) were included for further analysis. A flow chart of our analysis protocol is shown in Figure 1.…”

Section: Search Results and Characteristics Of The Included Studiesmentioning

confidence: 99%

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RETRACTED: Laparoscopic vs. Open Pancreaticoduodenectomy After Learning Curve: A Systematic Review and Meta-Analysis of Single-Center Studies

et al. 2021

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Background: Although laparoscopic pancreaticoduodenectomy (LPD) is a safe and feasible treatment compared with open pancreaticoduodenectomy (OPD), surgeons need a relatively long training time to become technically proficient in this complex procedure. In addition, the incidence of complications and mortality of LPD will be significantly higher than that of OPD in the initial stage. This meta-analysis aimed to compare the safety and overall effect of LPD to OPD after learning curve based on eligible large-scale retrospective cohorts and randomized controlled trials (RCTs), especially the difference in the perioperative and short-term oncological outcomes.Methods: PubMed, Web of Science, EMBASE, Cochrane Central Register, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Only clinical studies reporting more than 40 cases for LPD were included. Data on operative times, blood loss, and 90-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien–Dindo ≥III complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, positive lymph node numbers, and tumor size) were subjected to meta-analysis.Results: Overall, the final analysis included 13 retrospective cohorts and one RCT comprising 2,702 patients (LPD: 1,040, OPD: 1,662). It seems that LPD has longer operative time (weighted mean difference (WMD): 74.07; 95% CI: 39.87–108.26; p < 0.0001). However, compared with OPD, LPD was associated with a higher R0 resection rate (odds ratio (OR): 1.43; 95% CI: 1.10–1.85; p = 0.008), lower rate of wound infection (OR: 0.35; 95% CI: 0.22–0.56; p < 0.0001), less blood loss (WMD: −197.54 ml; 95% CI −251.39 to −143.70; p < 0.00001), lower blood transfusion rate (OR: 0.58; 95% CI 0.43–0.78; p = 0.0004), and shorter LOS (WMD: −2.30 day; 95% CI −3.27 to −1.32; p < 0.00001). No significant differences were found in 90-day mortality, overall morbidity, Clavien–Dindo ≥ III complications, reoperation, POPF, DGE, PPH, lymph node dissection, positive lymph node numbers, and tumor size between LPD and OPD.Conclusion: Comparative studies indicate that after the learning curve, LPD is a safe and feasible alternative to OPD. In addition, LPD provides less blood loss, blood transfusion, wound infection, and shorter hospital stays when compared with OPD.

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Section: Search Results and Characteristics Of The Included Studiesmentioning

confidence: 99%

“…Fourteen studies (5,7,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) with a total of 2,702 patients (1,040 patients who underwent LPD and 1,662 patients who underwent OPD) reported operative times. We found that operative time was longer in the LPD group (WMD: 74.07 min; 95% CI: 39.87-108.26; p < 0.00001).…”

Section: Operative Outcomesmentioning

confidence: 99%

RETRACTED: Laparoscopic vs. Open Pancreaticoduodenectomy After Learning Curve: A Systematic Review and Meta-Analysis of Single-Center Studies

et al. 2021

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“…In patients with tumors confined to the pancreas, minimally invasive DP was associated with early functional recovery and better quality of life compared with open DP 23 . A comparison of laparoscopic and open approaches for PNETs at the pancreatic head found that laparoscopic pancreaticoduodenectomy has advantages, including a shorter recovery time and reduced hospital stay 24 . Taken together, these findings indicate that minimally invasive resection should be considered for patients with PNET, especially for those with small tumors.…”

Section: Discussionmentioning

confidence: 90%

The clinicopathologic and operative characteristics of patients with small nonfunctioning pancreatic neuroendocrine tumors

Song

Hong

et al. 2021

ANZ Journal of Surgery

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Background Incidentally detected, small nonfunctioning pancreatic neuroendocrine tumors (NF‐PNETs) are increasingly diagnosed on imaging modalities. This retrospective investigation evaluated the clinicopathologic characteristics and perioperative and oncologic outcomes in patients with small NF‐PNETs undergoing curative resection. Methods The medical records of 444 patients who underwent pancreatic resection for NF‐PNETs at a single, large‐volume institution between January 2000 and December 2018 were retrospectively reviewed. Patients were divided into those with small (≤2 cm) and large (>2 cm) tumors based on the largest tumor diameter on preoperative computed tomography (CT). Outcomes were also evaluated in subgroups of patients with small NF‐PNET who did and did not undergo lymphadenectomy. Results Of the 444 patients with NF‐PNETs, 195 (43.9%) had small (≤2 cm) and 249 (56.1%) had large (>2 cm) NF‐PNETs. The rate of parenchyma‐preserving surgery (14.4% vs. 7.2%, p = 0.014) and the ratio of spleen preservation for left‐sided pancreatectomy (65.6% vs. 38.3%, p < 0.001) were higher in the small NF‐PNET group. Size on CT >2 cm (p < 0.001, hazard ratio [HR]: 5.836, 95% confidence interval [CI]: 2.474–13.769), presence of perineural invasion (p < 0.001, HR: 3.025, 95% CI: 1.640–5.577), World Health Organization (WHO) Grade 2 (p = 0.007, HR: 2.861, 95% CI: 1.325–6.176), and WHO Grade 3 (p < 0.001, HR: 11.537, 95% CI: 5.282–25.199) were independent predictors of disease‐free survival (DFS). DFS did not differ significantly in patients with small NF‐PNETs who did and did not undergo lymphadenectomy (p = 0.886). Conclusions Assessment of long‐term oncologic outcomes suggests that surgical resection may cure small NF‐PNETs. Minimally invasive surgery and organ‐preserving surgery are acceptable treatment options for select patients with small NF‐PNETs. The effect on survival outcomes of lymph node dissection for small NF‐PNETs remains unclear.

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“…Although various studies have demonstrated that age is an important factor responsible for postoperative complications, ICU admission, and surgical mortality in PD [29,30,12], it may still be performed safely and provide survival bene t to elderly patients [31]. MIS has been shown to be safe and effective in many gastrointestinal surgeries, with typical bene ts including reduced postoperative pain, faster ambulation, less abdominal wall complications, and shorter POHS [32][33][34][35]. Despite these advantages, achievement of similar bene ts in elderly patients undergoing MIPD remains questionable.…”

Section: Discussionmentioning

confidence: 99%

“…The time of initiation of oral diet, ICU stay, TPN dependence, and time taken for ambulation were comparable between the groups. Many recent studies have reported that MIPD enabled early recovery, reduced postoperative pain and the need for analgesic injections [36,37], less delayed gastric emptying rate [38,39] and shortened the duration of POHS [40,32,41,39,35]. However, MIPD did not completely mitigate the postoperative risk in elderly patients, and evidence regarding the bene ts of the approach in this population remains limited.…”

Section: Discussionmentioning

confidence: 99%

Short-term Outcomes after Minimally Invasive versus Open Pancreaticoduodenectomy in Elderly Patients: a Propensity Score-matched Analysis

Yin

Liu

et al. 2020

Preprint

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Background: To date, the evidence on the safety and benefits of minimally invasive pancreatoduodenectomy (MIPD) in elderly patients is still controversy. This study aim to compare the risk and benefit between MIPD and open pancreatoduodenectomy (OPD) in elderly patients. Methods: From 2016 to 2020, we retrospective enrolled 26 patients underwent MIPD and other 119 patients underwent OPD. Propensity score matching was applied for old age (≥ 65-year-old) patient analysis. Baseline characteristics, 90-day mortality and short-term surgical outcomes were compared between two groups. Results: After 1:2 propensity score matching analysis, elderly patients in MIPD group had significantly poor performance status (P = 0.042) compared to OPD group. Patients receiving MIPD had significantly shorter postoperative hospital stay (POHS) (18 vs. 25 days, P = 0.028), earlier drain removal (16 vs. 21 days, P = 0.012) and smaller delay gastric empty rate (5.9 vs. 32.4% P = 0.036). There was no 90-day mortality (0% vs 11.8%, P = 0.186) and pulmonary complications (0% vs 17.6%, P = 0.075) in MIPD group, and the major complication rate is comparable to OPD group (17.6% vs 29.4%, P = 0.290). Conclusion: For elderly patients, MIPD is a feasible and safe option even in patients with inferior preoperative performance status. MIPD might also provide potential advantage for elderly patients in minimizing pulmonary complication and overall mortality over OPD.

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Laparoscopic versus open pancreaticoduodenectomy for pancreatic neuroendocrine tumors: a single-center experience

Cited by 17 publications

References 28 publications

RETRACTED: Laparoscopic vs. Open Pancreaticoduodenectomy After Learning Curve: A Systematic Review and Meta-Analysis of Single-Center Studies

RETRACTED: Laparoscopic vs. Open Pancreaticoduodenectomy After Learning Curve: A Systematic Review and Meta-Analysis of Single-Center Studies

The clinicopathologic and operative characteristics of patients with small nonfunctioning pancreatic neuroendocrine tumors

Short-term Outcomes after Minimally Invasive versus Open Pancreaticoduodenectomy in Elderly Patients: a Propensity Score-matched Analysis

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