The effectiveness, risks and improvement of laparoscopic pancreaticoduodenectomy during the learning curve: a propensity score-matched analysis

Abstract

Background: Propensity score-matched analyses comparing the safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) to open pancreaticoduodenectomy (OPD) that consider the effect of the learning curve for LPD are lacking. We use Propensity score-matched to compare the safety and efficacy of LPD during the learning curve to OPD. Methods:The medical records of 296 consecutive patients who had undergone LPD or OPD between September 2016 and August 2019 at Fujian Provincial Hospital were retrospectively reviewed. Patients treated with LPD were matched 1:1 to those treated with OPD. Calculation of propensity scores considered age, gender, body mass index (BMI), tumor location, pathology, incidence of obstructive jaundice, incidence of biliary drainage, pancreatic texture, pancreatic duct diameter, previous abdominal surgery, comorbidities, and case distribution of the surgical team.Results: After propensity score matching, 196 patients were divided into two groups: 98 patients in the LPD group and 98 patients in the OPD group. LPD performed during the learning curve was associated with a longer median operative time (OT) (432 vs. 328 min, P<0.001), a higher incidence of major surgeryassociated complications (32.7% vs. 14.3%, P=0.002), a higher incidence of clinically relevant pancreatic fistula (27.6% vs. 13.3%, P=0.013), and prolonged LOS (21.06 d vs. 16.94 d, P=0.033), but lower median intraoperative blood loss (200 vs. 300 mL, P<0.001) compared to OPD. Mean OT and LOS were significantly shorter in the late phase of the learning curve for LPD (P<0.001), and were similar to that for OPD. Age >60 years and a non-dilated MPD were significant predictors of clinically relevant pancreatic fistula, major surgery-associated complications, prolonged LOS and postoperative mortality at 90 days (all P<0.05).Conclusions: OT, incidence of major surgery-associated complications, and LOS were significantly increased in patients that underwent LPD, but were significantly improved during the learning curve. Elderly patients and patients with a non-dialated MPD should not be treated with LPD performed by inexperienced surgeons.

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

“…The literature search yielded 534 relevant English publications from the various electronic databases, of which 15 retrospective cohort studies and 3 RCTs (5,7,11,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) comparing LPD and OPD in a total of 12,495 patients (2,037 and 10,458 underwent LPD and OPD, respectively) were included for further analysis. A flow chart of our analysis protocol is shown in Figure 1.…”

“…Estimated blood loss was assessed in 11 studies (5,7,15,17,18,20,22,(25)(26)(27)29). The pooled data further showed that LPD was associated with a less blood loss (WMD: −212.25 mL; 95% CI: −286.15 to -138.14; P<0.00001).…”

“…Blood transfusion rate data was available in 8 studies (16,18,20,22,23,(27)(28)(29). The meta-analysis suggested a higher rate of blood transfusion in the OPD group (OR: 0.58; 95% CI: 0.43 to 0.77; P=0.0002).…”

“…All studies (5,7,11,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) with a total of 14,565 patients (2,037 who underwent LPD and 10,518 who underwent OPD) investigated the LOS. The meta-analysis suggested a shorter LOS in the LPD group (MD: -1.62; 95% CI: -2.73 to -0.51; P=0.004) (Figure 4A).…”

Nomogram based on albumin and neutrophil-to-lymphocyte ratio for predicting postoperative complications after pancreaticoduodenectomy

“…Comparisons for the risk of complications between laparoscopic and open PD differs among different studies. While some studies have reported higher rates of complications after laparoscopic PD relative to open PD (44)(45)(46), several other studies have shown the opposite results (47,48). In this study, compared to those with laparotomy, patients underwent total laparoscopy had significant lower complication rate (39.6% vs. 67.7%; P<0.001).…”