Hybrid Laparoscopic Versus Open Pancreatoduodenectomy. A Meta-Analysis

Abstract

Introduction: Hybrid laparoscopic techniques have been proposed as a good transition from open to complete minimally invasive approach especially in complex surgical procedures. This meta-analysis aimed to compare the outcomes of hybrid laparoscopic pancreatoduodenectomy versus open pancreatoduodenectomy.

Methods: A systematic literature research was performed according to PRISMA guidelines. A broad search strategy with terms "laparoscopy" and "pancreatoduodenectomy" was used. Included studies were analyzed by quantitative meta-analysis using the metafor package for R software.

Results: Of 655 identified articles, 627 were excluded and 28 articles fully assessed, including 14 comparative studies, 8 case series and 6 case reports. Extracted data included intraoperative variables and postoperative outcome parameters. The predefined inclusion criteria were met by 14 comparative studies, and 371 patients were pooled in the meta-analysis. Hybrid laparoscopic pacreatoduodenectomy was associated with significantly longer operative time (I² 0%, p = 0,01, Mean HPD 494,6 min, Mean OPD 421,6 min, WMD 67 min, 95% CI 14-120 min). For all other postoperative outcome parameters, no statistically significant differences were found. A nonsignificant reduction in intraoperative transfusion rate (I² 20%, p = 0,2, proportion HPD 2%, proportion OPD 1,6%, OR 0,44, 95% CI 0,16-1,27) and blood loss (I² 95%, p = 0,1, Mean HPD 397,2 ml, Mean OPD 1017,8 ml, MD - 601 ml, 95% CI - 1311-108) was observed for hybrid pancreatoduodenectomy in comparison to open surgery.

Conclusions: This meta-analysis demonstrates significantly increased operation time for hybrid laparoscopic compared to open pancreatoduodenectomy. Intraoperative variables as well as postoperative parameters and major morbidity were comparable for both techniques. Overall results of this meta-analysis demonstrated the hybrid technique as a safe procedure in high-volume centers offering aspects of a safe transition to fully laparoscopic pancreatoduodenectomy.

Fig. 1

The PRISMA flowchart of literature review

Fig. 2

Forest plot; average operative time of all HPD`s in minutes

Fig. 3

Forest plot; mean difference of operative time in comparative studies (comparison between HPD and OPD)

Fig. 4

Forest plot; transfusion rate of all HPD`s

Fig. 5

Forest plot; transfusion rate in comparative studies (comparison between HPD and OPD)

Fig. 6

Forest plot; average intraoperative blood loss of all HPD’s in milliliter

Fig. 7

Forest plot; mean difference in intraoperative blood loss between HPD and OPD in milliliter

Fig. 8

Forest plot; conversion rate of all HPD’s

Fig. 9

Forest plot; pancreatic fistula B/C rate of all HPD’s

Fig. 10

Forest plot; pancreatic fistula B/C rate in comparative studies (comparison between HPD and OPD)

Fig. 11

Forest plot; mortality of all HPD’s

Fig. 12

Forest plot; mortality rate in comparative studies (comparison between HPD and OPD)