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Meta-Analysis
. 2014 Aug 13;9(8):e104274.
doi: 10.1371/journal.pone.0104274. eCollection 2014.

Does minimally-invasive pancreaticoduodenectomy have advantages over its open method? A meta-analysis of retrospective studies

Han Qin  1 , Jianguo Qiu  2 , Yiyang Zhao  3 , Gang Pan  1 , Yong Zeng  1
Affiliations
Meta-Analysis

Does minimally-invasive pancreaticoduodenectomy have advantages over its open method? A meta-analysis of retrospective studies

Han Qin et al. PLoS One. .

Abstract

Background: While more and more open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Therefore, we carried out this meta-analysis to evaluate whether MIPD is safe, feasible and worthwhile.

Methods: PubMed, EMBASE, and Cochrane Library were searched to identify studies published between January 1994 and November 2013 comparing MIPD with open pancreaticoduodenectomy (OPD). Intraoperative outcomes, oncologic safety, postoperative complications, and postoperative recovery were evaluated.

Results: 11 retrospective studies representing 869 patients (327 MIPDs, 542 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (MD -361.93 ml, 95% CI -519.22 to -204.63 ml, p<0.001, I(2) = 94%), wound infection (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007, I(2) = 0%), and hospital stay (MD -2.64 d, 95% CI -4.23 to -1.05 d, p = 0.001, I(2) = 78%). However, it brings longer operative time (MD 105 min, 95% CI 49.73 to 160.26 min, p<0.001, I(2) = 93%). There were no significant differences between the two procedures in likelihood of overall complications (p = 0.05), pancreatic fistula (PF) (p = 0.86), delayed gastric empting (DGE) (p = 0.96), positive surgical margins (p = 0.07), retrieval of lymph nodes (p = 0.48), reoperation (p = 0.16) and mortality (p = 0.64).

Conclusions: Our results suggest that MIPD is currently safe, feasible and worthwhile. But considering the selection bias, complexity of MIPD and lack of long-term oncologic outcomes, we suggest it be performed in a high-volume pancreatic surgery center in selected patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The PRISMA flowchart of literature review.
Figure 2
Figure 2. Pooled meta-analysis of pancreatic fistula, comparing MIPD with OPD.
Figure 3
Figure 3. Pooled meta-analysis of length of stay, comparing MIPD with OPD.
Figure 4
Figure 4. Pooled meta-analysis of positive surgical margins, comparing MIPD with OPD.
Figure 5
Figure 5. Funnel plot of overall complications in included studies, showing no publication bias.
See this image and copyright information in PMC

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