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Meta-Analysis
. 2017 Aug;402(5):841-851.
doi: 10.1007/s00423-017-1583-8. Epub 2017 May 9.

Minimally invasive versus open pancreatoduodenectomy-systematic review and meta-analysis

Michał Pędziwiatr  1   2   3 , Piotr Małczak  4   5   6 , Magdalena Pisarska  4   5   6 , Piotr Major  4   5   6 , Michał Wysocki  4   5   6 , Tomasz Stefura  4   5 , Andrzej Budzyński  4   5   6
Affiliations
Meta-Analysis

Minimally invasive versus open pancreatoduodenectomy-systematic review and meta-analysis

Michał Pędziwiatr et al. Langenbecks Arch Surg. 2017 Aug.

Abstract

Purpose: The purpose of this systematic review was to compare minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) by using meta-analytical techniques.

Methodology: Medline, Embase, and Cochrane Library were searched for eligible studies. Data from included studies were extracted for the following outcomes: operative time, overall morbidity, pancreatic fistula, delayed gastric emptying, blood loss, postoperative hemorrhage, yield of harvested lymph nodes, R1 rate, length of hospital stay, and readmissions. Random and fix effect meta-analyses were undertaken.

Results: Initial reference search yielded 747 articles. Thorough evaluation resulted in 12 papers, which were analyzed. The total number of patients was 2186 (705 in MIPD group and 1481 in OPD). Although there were no differences in overall morbidity between groups, we noticed reduced blood loss, delayed gastric emptying, and length of hospital stay in favor of MIPD. In contrary, meta-analysis of operative time revealed significant differences in favor of open procedures. Remaining parameters did not differ among groups.

Conclusion: Our review suggests that although MIPD takes longer, it may be associated with reduced blood loss, shortened LOS, and comparable rate of perioperative complications. Due to heterogeneity of included studies and differences in baseline characteristics between analyzed groups, the analysis of short-term oncological outcomes does not allow drawing unequivocal conclusions.

Keywords: Laparoscopy; Pancreatic cancer; Pancreatoduodenectomy; Robotic surgery; Whipple procedure.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Figures

Fig. 1
Fig. 1
Flowchart of the studies
Fig. 2
Fig. 2
Pooled estimates of operative time comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
Fig. 3
Fig. 3
Pooled estimates of blood loss comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
Fig. 4
Fig. 4
Pooled estimates of morbidity comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
Fig. 5
Fig. 5
Pooled estimates of fistula cases comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
Fig. 6
Fig. 6
Pooled estimates of delayed gastric emptying cases comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
Fig. 7
Fig. 7
Pooled estimates of harvested lymph nodes comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
Fig. 8
Fig. 8
Pooled estimates of R1 resection comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
Fig. 9
Fig. 9
Pooled estimates of length of hospital stay comparing mini-invasive pancreatoduodenectomy versus open surgery. CI confidence interval, df degrees of freedom
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References

    1. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–410. doi: 10.1007/BF00642443. - DOI - PubMed
    1. Lassen K, Coolsen MME, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2012;37:240–258. doi: 10.1007/s00268-012-1771-1. - DOI - PubMed
    1. Correa-Gallego C, Dinkelspiel HE, Sulimanoff I, et al. Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg. 2014;218:129–139. doi: 10.1016/j.jamcollsurg.2013.09.005. - DOI - PubMed
    1. Song KB, Kim SC, Hwang DW, et al. Matched case-control analysis comparing laparoscopic and open pylorus-preserving pancreaticoduodenectomy in patients with periampullary tumors. Ann Surg. 2015;262:146–155. doi: 10.1097/SLA.0000000000001079. - DOI - PubMed
    1. Wellner UF, Küsters S, Sick O, et al. Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbeck’s Arch Surg. 2014;399:849–856. doi: 10.1007/s00423-014-1236-0. - DOI - PubMed

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