Perioperative and short-term oncological outcomes following laparoscopic versus open pancreaticoduodenectomy after learning curve in the past 10 years: a systematic review and meta-analysis

Abstract

Background: To compare perioperative and short-term oncologic outcomes of laparoscopic pancreaticoduodenectomy (LPD) to open pancreaticoduodenectomy (OPD) using data from large-scale retrospective cohorts and randomized controlled trials (RCTs) in the last 10 years.Methods: A meta-analysis to assess the safety and feasibility of LDP and OPD registered with PROSPERO: (CRD42020218080) was performed according to the PRISMA guidelines. Studies comparing LPD with OPD published between January 2010 and October 2020 were included; only clinical studies reporting more than 30 cases for each operation were included. Two authors performed data extraction and quality assessment independently. The primary endpoint was operative times, blood loss, and 90 days mortality. Secondary endpoints included reoperation, length of hospital stay (LOS), morbidity, Clavien-Dindo ≥3 complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0-resection, lymph node dissection).Results: Overall, the final analysis included 15 retrospective cohorts and 3 RCTs comprising 12,495 patients (2,037 and 10,458 patients underwent LPD and OPD). It seems OPD has more lymph nodes harvested but no significant differences [weighted mean difference (WMD): 1.08; 95% confidence interval (CI): 0.02 to 2.14; P=0.05]. Nevertheless, compared with OPD, LPD was associated with a higher R0

Is robotic distal pancreatectomy better than laparoscopic distal pancreatectomy after the learning curve? A systematic review and meta-analysis

“…dissections. Similar radical effects can be considered between RDP and LDP, which is consistent with major existing clinical studies (7,22,24,25,29,38). Meanwhile, this study shows that no significant difference was observed in reoperation, blood transfusion, readmission, overall complication rates, POPF, and major complications (Clavien-Dindo≥3/4 grade) between the RDP group and LDP group, showing that RDP is as safe as LPD after the learning curve.…”

“…Recent studies have shown that the operative time and length of hospital stay were the same between RDP and LDP, as most clinical trials have shown ( 22 , 24 , 26 ). Distal pancreatectomy with negative margin and lymph node dissection are two important prognosis factors ( 7 , 22 , 38 ). Based on the tumor radical effect, our study showed that there was no difference in RDP and LDP lymph node dissections.…”

An analysis of risk factors for clinically relevant pancreatic fistulas after laparoscopic pancreaticoduodenectomy

“…[8] In 1994, Gagner and Pomp performed the first laparoscopic pancreaticoduodenectomies and opened the way for the development of laparoscopic technology in this field. [9–11] However, the postoperative recovery of the patients was unsatisfactory. [9–11] Due to the surgical complexity and the high rate of postoperative complications, the clinical development of LPD has been questioned, and its clinical application has been halted.…”

“…[9–11] However, the postoperative recovery of the patients was unsatisfactory. [9–11] Due to the surgical complexity and the high rate of postoperative complications, the clinical development of LPD has been questioned, and its clinical application has been halted.…”

Glucose Regulation after Partial Pancreatectomy: A Comparison of Pancreaticoduodenectomy and Distal Pancreatectomy in the Short and Long Term

“…Traditionally, pancreatic surgery was regarded as a dangerous procedure associated with high morbidity and mortality rates. However, advances in surgical techniques and perioperative care, combined with minimally invasive surgery, have resulted in improved postoperative outcomes and enhanced recovery after Diabetes Metab J 2023;47:703-714 https://e-dmj.org pancreatic resection [2,3]. With the introduction of effective chemotherapy regimens, survival outcomes after pancreatectomy have also been improving in patients with pancreatic cancer [4][5][6].…”