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

Abstract

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.

Efficacy of laparoscopic pancreaticoduodenectomy at Henan University People’s Hospital: a review of 199 cases

“…[13] reported a postoperative complication rate of 37.2%, which is not different from 35.7% reported in our study. Besides, LPD is associated with fast recovery and shorter postoperative hospital stay days compared to OPD [10] . The postoperative hospital stay days in our analysis was 17 (13,24) days, which is consistent with 18.6 ± 5.6 days in previous data by Cheng, J. F. [14] .…”

“…Comparison of OPD with LPD showed that LPD leads to less bleeding and lower transfusion rate than OPD due to the magni cation of the eld of view by laparoscopy [9,10] . Our study showed that intraoperative blood loss was 200 (200, 400) ml, ndings that were comparable to a previous study which showed intraoperative blood loss of 350 (290-450) ml [11] .…”

Total laparoscopic pancreaticoduodenectomy with left posterior superior mesenteric artery first-approach and plexus-preserving circumferential lymphadenectomy: step-by-step technique with a surgical case report (with video)

“…The development of technology and minimally invasive tendency in medicine and minimally invasive pancreaticoduodenectomy, especially total laparoscopic pancreaticoduodenectomy (tLPD), is not out of this way. Recent systematic reviews showed that LPD was superior against open PD in aspects of inoperative blood transfusion, wound and pulmonary infection, and shorter hospital stays, and there are no differences of relevant postoperative pancreatic fistula (POPF), severe complications, postoperative mortality, retrieved lymph nodes (LNs), and R0 resection rate [3,4]. However, to achieve the safety and effectiveness, they also recommended that LPD should be done by surgeons with expertise and through learning curve in high-volume centers [3,4].…”

Clinical Application of 3D Visualization Technology in Pancreatoduodenectomy

“…Since PD surgery requires the removal of several organs and complex anatomical relationships, as well as reconstruction of the digestive tract, the early postoperative mortality rate is 20-30%. In recent years, with the rapid development of surgical techniques and careful planning of the perioperative period, the mortality rate has decreased to less than 5% [1], but the postoperative complication rate remains relatively high [2][3][4], so PD is one of the most complicated procedures in abdominal surgery. Therefore, surgeons need to do early accurate diagnosis for such tumors, make clear the situation, such as the size the shape and adjacent organs of the tumor, whether the surrounding vascular system was invaded by the tumor, etc.…”

“…Figure 4 1. Relationship between tumor and artery,2 Relationship between tumor and vein,3 Relationship between tumor and portal vein,4 Distribution of lymph nodes (green is suspected lymph node).Surg. Tech.…”