Laparoscopic Pancreaticoduodenectomy Versus Conventional Open Approach for Patients With Pancreatic Duct Adenocarcinoma: An Up-to-Date Systematic Review and Meta-Analysis

Abstract

Background: To compare perioperative and oncological outcomes of pancreatic duct adenocarcinoma (PDAC) after laparoscopic versus open pancreaticoduodenectomy (LPD vs. OPD), we performed a meta-analysis of currently available propensity score matching studies and large-scale retrospective cohorts to compare the safety and overall effect of LPD to OPD for patients with PDAC.

Methods: A meta-analysis was registered at PROSPERO and the registration number is CRD42021250395. PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Data on operative times, blood loss, 30-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien-Dindo ≥3 complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, overall survival, and long-term survival) were subjected to meta-analysis.

Results: Overall, we identified 10 retrospective studies enrolling a total of 11,535 patients (1,514 and 10,021 patients underwent LPD and OPD, respectively). The present meta-analysis showed that there were no significant differences in overall survival time, 1-year survival, 2-year survival, 30-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, and lymph node dissection between the LPD and OPD groups. Nevertheless, compared with the OPD group, LPD resulted in significantly higher rate of R0 resection (OR: 1.22; 95% CI 1.06-1.40; p = 0.005), longer operative time (WMD: 60.01 min; 95% CI 23.23-96.79; p = 0.001), lower Clavien-Dindo grade ≥III rate (p = 0.02), less blood loss (WMD: -96.49 ml; 95% CI -165.14 to -27.83; p = 0.006), lower overall morbidity rate (OR: 0.65; 95% CI 0.50 to 0.85; p = 0.002), shorter LOS (MD = -2.73; 95% CI -4.44 to -1.03; p = 0.002), higher 4-year survival time (p = 0.04), 5-year survival time (p = 0.001), and earlier time to starting adjuvant chemotherapy after surgery (OR: -10.86; 95% CI -19.42 to -2.30; p = 0.01).

Conclusions: LPD is a safe and feasible alternative to OPD for patients with PDAC, and compared with OPD, LPD seemed to provide a similar OS.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Keywords: laparoscopic; meta-analysis; pancreatic ductal adenocarcinoma; pancreaticoduodenectomy; whipple.

Figure 1

Flowchart of study identification and selection.

Figure 2

Forest plot of the comparison of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) for operative outcomes. (A) Forest plot for operative time; (B) forest plot for blood loss; (C) forest plot for blood transfusion.

Figure 3

Forest plot of the comparison of LPD versus OPD for postoperative outcomes. (A) Forest plot for overall complication rates; (B) forest plot for Clavien–Dindo grade ≥III; (C) forest plot for 30-day mortality.

Figure 4

Forest plot of the comparison of LPD versus OPD for overall complication rates. (A) Forest plot for postoperative pancreatic fistula; (B) forest plot for delayed gastric emptying; (C) forest plot for postpancreatectomy hemorrhage; (D) forest plot for length of stay.

Figure 5

Forest plot of the comparison of LPD versus OPD for short−term oncological outcomes. (A) Forest plot for R0 resection rate; (B) forest plot for lymph node dissection.

Figure 6

Forest plot of the comparison of LPD versus OPD for overall survival time.

Figure 7

Forest plot of the comparison of LPD versus OPD for long−term oncological outcomes. (A) Forest plot for 1-year survival time; (B) forest plot for 2-year survival time; (C) forest plot 3-year survival time; (D) forest plot for 4-year survival time; (E) forest plot for 5-year survival time.

Figure 8

Forest plot of the comparison of LPD versus OPD for time to starting adjuvant chemotherapy after surgery.

Figure 9

Funnel plots for R0 rate (A) and overall survival (B).