Minimally invasive pancreaticoduodenectomy for periampullary disease: a comprehensive review of literature and meta-analysis of outcomes compared with open surgery

Abstract

BackgroundMinimally invasive pancreatoduodenectomy (MIPD) has been gradually attempted. However, whether MIPD is superior, equal or inferior to its conventional open pancreatoduodenectomy (OPD) is not clear.MethodsStudies published up to May 2017 were searched in PubMed, Embase, Cochrane Library, and Web of Science. Main outcomes were comprehensively reviewed and measured including conversion to open approach, operation time (OP), estimated blood loss (EBL), transfusion, length of hospital stay (LOS), overall complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), readmission, reoperation and reasons of preoperative death, number of retrieved lymph nodes (RLN), surgical margins, recurrence, and survival. The software of Review Manage version 5.1 was used for meta-analysis.ResultsOne hundred studies were included for systematic review and 26 out of them (totally 3402 cases, 1064 for MIPD, 2338 for OPD) were included for meta-analysis. In the early years, most articles were case reports or non-control case series studies, while in the last 6 years high-volume and comparative researches were increasing gradually. Systematic review revealed conversion rates of MIPD to OPD ranged from 0% to 40%. The mean or median OP of MIPD ranged from 276 to 657 min. The total POPF rates vary between 3.8% and 50% observed in all systematic reviewed studies. Meta-analysis demonstrated MIPD had longer OP (WMD = 99.4 min; 95%CI: 46.0 ~ 152.8, P < 0.01), lower blood loss (WMD = −0.54 ml; 95% CI, −0.88 ~ −0.20 ml; P < 0.01), lower transfusion rate (RR = 0.73, 95%CI: 0.57 ~ 0.94, P = 0.02), shorter LOS (WMD = −3.49 days; 95%CI: -4.83 ~ −2.15, P < 0.01). There was no significant difference in time to oral intake, postoperative complications, POPF, reoperation, readmission, perioperative mortality and number of retrieved lymph nodes.ConclusionOur study demonstrates MIPD is technically feasible and safety on the basis of historical studies. MIPD is associated with less blood loss, faster postoperative recovery, shorter length of hospitalization and longer operation time. These findings are waiting for being confirmed with robust prospective comparative studies and randomized clinical trials.Electronic supplementary materialThe online version of this article (10.1186/s12876-017-0691-9) contains supplementary material, which is available to authorized users.

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

“…Moreover, LPD was significantly associated with decreased blood loss in the Indian study, whereas LPD was associated with a lower major morbidity rate in the Spanish study . The advantages of LPD over its open counterpart have also been reported in numerous retrospective case–control studies …”

Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

“…Stauffer et al, reported a median operative time of 518 min, which was signi cantly longer than that in open surgery (140 min) [27]. The learning curve can be overcome in high volume centers, with average LPD operative times decreasing to less than 400 min [33]. However, due to tumor biology and the aggressiveness of the disease process, LPD for PDAC treatments are not commonly performed making it di cult to overcome the associated learning curve [6].A recent study from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) demonstrated that longer operative times were independently associated with worse perioperative outcomes after pancreatic resections [34].…”

Total laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis with meta-analysis

“…Stauffer et al, reported a median operative time of 518 min, which was signi cantly longer than that in open surgery (140 min) [22]. The learning curve can be overcome in high volume centers, with average TLPD operative times decreasing to less than 400 min [26]. However, due to tumor biology and the aggressiveness of the disease process, TLPD for PDAC treatments are not commonly performed making it di cult to overcome the associated learning curve [5].…”