Minimally-Invasive vs Open Pancreaticoduodenectomy: Systematic Review and Meta-Analysis

Correa‐Gallego, Camilo; Dinkelspiel, Helen E.; Sulimanoff, Isabel; Fisher, Sarah B.; Viñuela, Eduardo; Kingham, T. Peter; Fong, Yuman; DeMatteo, Ronald P.; D’Angelica, Michael I.; Jarnagin, William R.; Allen, Peter J.

doi:10.1016/j.jamcollsurg.2013.09.005

Cited by 158 publications

(125 citation statements)

References 41 publications

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“…[7] These studies have established the feasibility and comparable short term outcomes with that of open pancreaticoduodenectomy (OPD). One of the recent meta analysis has shown that in selected patients, minimally invasive pancreaticoduodenectomy is associated with lesser blood loss, decreased hospital stay, higher lymph node yield, b e t t e r R 0 r e s e c t i o n i n c o m p a r i s o n w i t h o p e n pancreaticoduodenectomy [8] . To address this issue of oncological adequacy of technique, for which lymph node yield and R0 status are surrogate markers, a study comparing pathological radicality between open and LPD, was undertaken at our institute.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Pathological Radicality between Open and Laparoscopic Pancreaticoduodenectomy in a Tertiary Centre

Senthilnathan

Palanivelu

Ramanujam

et al. 2015

Indian J Surg Oncol

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Laparoscopic pancreaticoduodenectomy (LPD) remained a formidable challenge owing to retroperitoneal location, difficult dissection near great vessels and critical intracorporeal anastomoses. Recent reviews of literature have established the feasibility and comparable short term outcomes of laparoscopic pancreaticoduodenectomy (LPD) with that of open pancreaticoduodenectomy (OPD). This study was undertaken to compare the pathological radicality of LPD with OPD. A prospective database of all patients who underwent standard pancreaticoduodenectomy from Mar 2006 to Feb 2011 was taken up for this study. 45 patients who underwent LPD and 118 patients who underwent OPD for periampullary and pancreatic head malignancy were taken up for analysis. The study groups were comparable in terms of age of presentation, ASA grades, comorbidity, type of surgery and BMI. There was no statistically significant difference with regard to tumor size, lymph node yield, node positivity rates, R1 rates and margin lengths. The pathological radicality of laparoscopic pancreaticoduodenectomy is comparable with that of open approach when performed by experienced minimal-access surgeons. Standardized protocols for evaluation of the resection margins should be mandatory in studies reporting outcomes of pancreaticoduodectomy.

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Section: Introductionmentioning

confidence: 99%

Comparison of Pathological Radicality between Open and Laparoscopic Pancreaticoduodenectomy in a Tertiary Centre

Senthilnathan

Palanivelu

Ramanujam

et al. 2015

Indian J Surg Oncol

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“…Laparoscopic pancreatoduodenectomy (LPD) was described first by (43)(44)(45). DOS was significantly shorter in several comparative studies (6 to 8 vs. 9 to 12.4 days, respectively) (40,43,44) whereas other studies (7,41) found no statistically significant difference.…”

Section: Pancreatoduodenectomy (Pd)mentioning

confidence: 99%

“…DOS was significantly shorter in several comparative studies (6 to 8 vs. 9 to 12.4 days, respectively) (40,43,44) whereas other studies (7,41) found no statistically significant difference. Conversion to open surgery was reported in 9.1% to 30.0% of cases, mostly due to venous invasion and intraoperative bleeding (7,44,46). Overall morbidity in LPD has been reported to range from 35-52%, however this difference was not found to be statistically significant between the surgical approaches (43,47,48).…”

Section: Pancreatoduodenectomy (Pd)mentioning

confidence: 99%

“…The reported incidences of clinical relevant POPF (grades B and C) described in several studies were fairly similar, ranging from 6.3% to 11.0% (45,49) in LPD and 5% to 9% (40,43) in open surgery. In their systematic review, CorreaGallego et al (44) described overall POPF rates of 21% (8% grade B and C) in LDP and 17% (7% grade B and C) in ODP. This is comparable with Boggi and colleagues (46), who found a 24.8% incidence (10.5% grade B and C) for POPF after LDP in their metaanalysis.…”

Section: Pancreatoduodenectomy (Pd)mentioning

confidence: 99%

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Laparoscopic pancreatic resection—a review

Justin

Fingerhut²,

Khatkov³

et al. 2016

Transl. Gastroenterol. Hepatol.

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“…[116][117][118][119] A 2014 review with very rigorous and statistical inclusion criteria, in which only six trials met the requirements, collected no more than 169 pancreatoduodenectomies carried out worldwide by a mini-invasive approach (laparoscopic or robotic). 120 Another more inclusive recent review 121 that assessed 638 patients who were operated on robotically or laparoscopically, or by the open approach, reported a reduced LOS and blood loss at the price of longer operative time and no difference in the incidence of fistulas. It is interesting to note that the most important review had to pool robotic cases with pure laparoscopic operations in order to reach a sufficient level of statistical power.…”

Section: Pancreasmentioning

confidence: 99%

Gastrointestinal robotic surgery: challenges and developments

Becchini¹,

Annecchiarico²,

Marino³

et al. 2015

RSRR

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Abstract:The rapid diffusion of new technologies in surgery, together with high expectations of both patients and the mass media, has led to many gastrointestinal procedures being approached using robots. Robotic technology seems to resolve many of the drawbacks of laparoscopic advanced procedures, such as anastomotic reconstructions, accurate lymphadenectomy, and vascular sutures. In addition, a deeper tridimensional steady vision with excellent high definition, the EndoWrist technology offering seven degrees of freedom, tremor filtration, scaled motion, optimal working ergonomics, and avoidance of the 'fulcrum effect', are the main strengths of the da Vinci ® system. The use of near-infrared technology and the possibility of tutoring through a double-console will most likely add many more advantages of this technology over laparoscopy alone. However, none of the gastrointestinal robotic interventions has reached a level of evidence-based efficacy that enables it to be routinely applied. The main limitations of robotic gastrointestinal procedures are represented by the learning curve, the higher costs of robotic surgery compared to traditional and laparoscopic surgery, and the longer operation times, including setup and organizational troubles. Moreover, while the limits of robotics for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies, and long-term follow-up is still lacking. On the other hand, a word of caution should be presented on the adoption of robotics in too many surgical units without the correct and formal technical background and third-party control to guarantee the best outcomes for patients at minimum risk. Therefore, the robotic treatment of gastrointestinal diseases requires a thorough analysis of the published evidence, in order to determine the correct indications and patient selection. This review aims to examine the evidence for the use of robotic surgery in both malignancies and benign disease arising from the gastrointestinal area. Future developments in robotics and ongoing areas of research are also analyzed.

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Minimally-Invasive vs Open Pancreaticoduodenectomy: Systematic Review and Meta-Analysis

Cited by 158 publications

References 41 publications

Comparison of Pathological Radicality between Open and Laparoscopic Pancreaticoduodenectomy in a Tertiary Centre

Comparison of Pathological Radicality between Open and Laparoscopic Pancreaticoduodenectomy in a Tertiary Centre

Laparoscopic pancreatic resection—a review

Gastrointestinal robotic surgery: challenges and developments

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