Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and meta-analysis

Hilst, Jony van; Korrel, Maarten; Rooij, Thijs de; Lof, Sanne; Busch, Olivier R.; Koerkamp, Bas Groot; Kooby, David A.; Dieren, Susan van; Hilal, Mohammed Abu; Besselink, Marc G.

doi:10.1016/j.ejso.2018.12.003

Cited by 71 publications

(45 citation statements)

References 41 publications

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“…In addition, patients who underwent MIDP had a lower incidence of severe complications. While a previous report reported comparable postoperative morbidity and mortality between MIDP and ODP, the study had suggested a superiority of MIDP over ODP for pancreatic ductal adenocarcinoma in terms of intraoperative blood loss and hospital stay . A separate study by Xoufras et al that examined patients who underwent DP for pNET noted that laparoscopic DP was associated with a lower incidence of postoperative complications and a shorter hospital stay vs ODP.…”

Section: Discussionmentioning

confidence: 94%

“…Of note, ODP was more frequently performed among patients with advanced disease in terms of tumor size, number, vascular resection, and nodal involvement. As such, patients terms of intraoperative blood loss and hospital stay 23. A separate study by Xoufras et al24 that examined patients who underwent DP for pNET noted that laparoscopic DP was associated with a lower incidence of postoperative complications and a shorter hospital stay vs ODP.…”

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confidence: 99%

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Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

Zhang

Lopez‐Aguiar

Poultsides

et al. 2019

Journal of Surgical Oncology

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Background To determine short‐ and long‐term oncologic outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for the treatment of pancreatic neuroendocrine tumor (pNET). Methods The data of the patients who underwent curative MIDP or ODP for pNET between 2000 and 2016 were collected from a multi‐institutional database. Propensity score matching (PSM) was used to generate 1:1 matched patients with MIDP and ODP. Results A total of 576 patients undergoing curative DP for pNET were included. Two hundred and fourteen (37.2%) patients underwent MIDP, whereas 362 (62.8%) underwent ODP. MIDP was increasingly performed over time (2000‐2004: 9.3% vs 2013‐2016: 54.8%; P < 0.01). In the matched cohort (n = 141 in each group), patients who underwent MIDP had less blood loss (median, 100 vs 200 mL, P < 0.001), lower incidence of Clavien‐Dindo ≥ III complications (12.1% vs 24.8%, P = 0.026), and a shorter hospital stay versus ODP (median, 4 versus 7 days, P = 0.026). Patients who underwent MIDP had a lower incidence of recurrence (5‐year cumulative recurrence, 10.1% vs 31.1%, P < 0.001), yet equivalent overall survival (OS) rate (5‐year OS, 92.1% vs 90.9%, P = 0.550) compared with patients who underwent OPD. Conclusion Patients undergoing MIDP over ODP in the treatment of pNET had comparable oncologic surgical metrics, as well as similar long‐term OS.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

Zhang

Lopez‐Aguiar

Poultsides

et al. 2019

Journal of Surgical Oncology

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“…But, this pan-European PSM study found the lower LN retrieval with LDP hardly impact on median OS (28 months vs. 31 months) [47]. Generally speaking, studies including meta-analyses showed promising long-term outcomes of LDP for PDAC [48][49][50][51].…”

Section: %mentioning

confidence: 79%

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

Chen

Pan

Huang

et al. 2020

Preprint

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Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most leading causes of cancer mortality worldwide. Laparoscopic pancreatic resection (LPR) has been widely used in the treatment of benign and low-grade pancreatic diseases. It is necessary to expand the current knowledge on the feasibility and safety of LPR for PDAC. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses, aiming to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD).Methods: Data of patients who underwent DP and PD for PDAC from January 2004 to February 2020 in our hospital were obtained. Baseline characteristics, intraoperative effect, postoperative recovery, and survival outcomes were compared. One-to-one PSM was used to minimize selection biases by balancing factors including age, sex, BMI, and tumor size.Results: Patient demographics were well matched after PSM. The DP subgroup included 86 LDP patients and 86 ODP patients, whereas the PD subgroup included 101 LPD patients and 101 OPD patients. Compared to ODP, LDP was associated with shorter operative time, less blood loss, and comparable overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. LPD was associated with longer operative time, less blood loss, and comparable overall morbidity. For oncological and survival outcomes, there were no significant differences in tumor sizes, R0 resection rate and tumor stage in both DP and PD subgroup. However, laparoscopic procedures seems to have an advantage over open surgery in terms of retrieved lymph node (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). There was no statistical signiﬁcance between both groups in recurrence pattern, and 3-year recurrence-free and overall survival were comparable between groups.Conclusions: Both LDP and LPD are feasible and oncologically safe procedures for PDAC. Postoperative outcomes and long-term survival of LDP and LPD are not inferior or superior to open surgery. However, the short-term surgical advantage of LPD is not as obvious as LDP mainly due to the conversions. Our findings should be further evaluated by multicenter or randomized controlled trials.

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“…Diese Frage soll in der derzeit rekrutierenden multinationalen DIPLOMA-Studie geklärt werden. Es gibt zwar systematische Reviews, die vergleichbare onkologische Langzeitergebnisse zeigen, jedoch leiden all diese Studien unter einem Selektionsbias, da kleinere und weniger fortgeschrittene Tumoren minimalinvasiv operiert wurden und größere Tumoren eher offen chirurgisch [13,14]. Trotz der stetigen Weiterentwicklung der minimalinvasiven Chirurgie bzw.…”

Section: Aufbau Der Robotisch Assistierten Pankreaschirurgieunclassified

Robotergestützte Bauchspeicheldrüsenchirurgie

et al. 2020

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Zusammenfassung Einführung Der Einsatz von Robotern in der minimalinvasiven Chirurgie hat in den letzten Jahren immer weiter zugenommen. Die roboterunterstützte Pankreaschirurgie hat gegenüber der laparoskopischen Pankreaschirurgie den Vorteil einer besseren Handhabung und verbesserten Angulation durch die größere Flexibilität der Instrumente. Darüber hinaus besteht durch die 3-D-Technik eine verbesserte Sicht und durch eine softwarebasierte Tremorkontrolle eine exakte Instrumentenführung. Die körperliche Belastung des Chirurgen durch die sitzende Position ist bei langen Eingriffen geringer. Methoden und Ergebnisse Dieser Artikel liefert einen Ansatz für die Einrichtung eines Roboter-Pankreas-Programms und eine detaillierte Anleitung im Sinne von SOPs für die robotergestützte Pankreaslinksresektion und robotergestützte Pankreatoduodenektomie. Ergebnisse In unserem standardisierten SOP-Ansatz verwenden wir sowohl bei der Pankreaslinksresektion als auch bei der Pankreatduodenektomie jeweils 5 Trokare – 4 Da-Vinci-Trokare und einen laparoskopischen Hilfstrokar. Wir bevorzugen die Position der Robotertrokare auf einer geraden horizontalen Linie mit einem Abstand von etwa 20 cm vom Operationsfeld. Die Operation wird in standardisierten Arbeitsschritten durchgeführt. Bei der Pankreaslinksresektion sind dies: Zugang und Visualisierung des Pankreas, Mobilisierung der linken Dickdarmflexur und des Pankreasunterrandes, Präparation der V. lienalis und der mesenterikoportalen Achse, Präparation des Pankreasoberrandes mit Lymphadenektomie und Darstellung der A. lienalis, Durchtrennung des Pankreas, retrograde Präparation des Pankreas und der Milz (bei onkologischen Eingriffen). Bergung, Einlage von Drainagen und Wundverschluss. Bei der Pankreatoduodenektomie sind es folgende Schritte: Zugang und Visualisierung des Pankreas, erweitertes Kocher-Manöver, Darstellung der Unterkante und der mesenterikoportalen Achse, Darstellung des Pankreasoberrandes und des Lig. hepatoduodenale, Präparation des Pankreashalses, Darstellung der Mesenterialwurzel und Pars IV duodeni, Präparation des Mesopankreas, Durchführung der Pankreasanastomose und der biliodigestiven Anastomose, Naht der dudenojejunalen Anastomose, Einlage von Drainagen und schichtweiser Wundverschluss. Der graduelle Aufbau unseres Roboter-Pankreas-Programms und der strukturierte Ansatz für komplexe Pankreasresektionen werden erläutert. Zusammenfassung Zusammenfassend beschreiben wir den Ansatz der robotischen Bauchspeicheldrüsenchirurgie in einem minimalinvasiven Exzellenzzentrum und Bauchspeicheldrüsenzentrum auf struktureller und verfahrenstechnischer Ebene, um die Einrichtung derartiger Programme an anderen Standorten zu unterstützen.

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Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and meta-analysis

Cited by 71 publications

References 41 publications

Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

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

Robotergestützte Bauchspeicheldrüsenchirurgie

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