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Meta-Analysis
. 2017 Dec;96(50):e8619.
doi: 10.1097/MD.0000000000008619.

Minimally invasive surgical approach versus open procedure for pancreaticoduodenectomy: A systematic review and meta-analysis

Shunda Wang  1 , Ning Shi, Lei You, Menghua Dai, Yupei Zhao
Affiliations
Meta-Analysis

Minimally invasive surgical approach versus open procedure for pancreaticoduodenectomy: A systematic review and meta-analysis

Shunda Wang et al. Medicine (Baltimore). 2017 Dec.

Abstract

Background: Minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Safety and feasibility remain controversial when comparing MIPD with open pancreaticoduodenectomy (OPD). The aim of this systematic review and meta-analysis was to evaluate the feasibility and safety of MIPD versus OPD.

Methods: A systematic review of the literature was performed to identify studies comparing MIPD and OPD. Postoperative complications, intraoperative outcomes and oncologic data, and postoperative recovery were compared.

Results: There were 27 studies that matched the selection criteria. Totally 1306 cases of MIPD and 5603 cases of OPD were included. MIPD was associated with a reduction in postoperative hemorrhage (odds ratio [OR] 1.60; 95% confidence interval [CI] 1.03-2.49; P = .04) and wound infection (OR 0.44, 95% CI 0.30-0.66, P < .0001). MIPD was also associated with less estimated blood loss (mean difference [MD] -300.14 mL, 95% CI -400.11 to -200.17 mL, P < .00001), a lower transfusion rate (OR 0.46, 95% CI 0.35-0.61; P < .00001) and a shorter length of hospital stay (MD -2.95 d, 95% CI -3.91 to -2.00 d, P < .00001) than OPD. Meanwhile, the MIPD group had a higher R0 resection rate (OR 1.45, 95% CI 1.18-1.78, P = .0003) and more lymph nodes harvested (MD 1.34, 95% CI 0.14-2.53, P = .03). However, the minimally invasive approach proved to have much longer operative time (MD 71.00 minutes; 95% CI 27.01-115.00 minutes; P = .002) than OPD. Finally, there were no significant differences between the 2 procedures in postoperative pancreatic fistula (P = .30), delayed gastric emptying (P = .07), bile leakage (P = .98), mortality (P = .88), tumor size (P = .15), vascular resection (P = .68), or reoperation rate (P = .11).

Conclusions: Our results suggest that MIPD is currently safe, feasible, and worthwhile. Future large-volume, well-designed randomized controlled trials (RCT) with extensive follow-up are awaited to further clarify this role.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
A PRISMA flow diagram depicting the selection process.
Figure 2
Figure 2
Forest plot and meta-analysis of pancreatic fistula, comparing MIPD with OPD.
Figure 3
Figure 3
Forest plot and meta-analysis of wound infection, comparing MIPD with OPD.
Figure 4
Figure 4
Forest plot and meta-analysis of postoperative hemorrhage, comparing MIPD with OPD.
Figure 5
Figure 5
Forest plot and meta-analysis of operation time, comparing MIPD with OPD.
Figure 6
Figure 6
Forest plot and meta-analysis of EBL, comparing MIPD with OPD.
Figure 7
Figure 7
Forest plot and meta-analysis of transfusion rate, comparing MIPD with OPD.
Figure 8
Figure 8
Forest plot and meta-analysis of length of hospital days.
Figure 9
Figure 9
Forest plot and meta-analysis of lymph node harvested, comparing MIPD with OPD.
Figure 10
Figure 10
Forest plot and meta-analysis of R0 resection, comparing MIPD with OPD.
Figure 11
Figure 11
Funnel plot of complications in included studies, showing no publication bias.
See this image and copyright information in PMC

References

    1. Park KB, Kwon OK, Yu W, et al. Body composition changes after totally laparoscopic distal gastrectomy with delta-shaped anastomosis: a comparison with conventional Billroth I anastomosis. Surg Endosc 2016;30:4286–93. - PubMed
    1. Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 2005;241:232–7. - PMC - PubMed
    1. Seiler CA, Wagner M, Bachmann T, et al. Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg 2005;92:547–56. - PubMed
    1. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935;102:763–79. - PMC - PubMed
    1. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994;8:408–10. - PubMed

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