Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 25:12:1093395.
doi: 10.3389/fonc.2022.1093395. eCollection 2022.

Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

Yong Yan  1 , Yinggang Hua  1 , Cheng Chang  1 , Xuanjin Zhu  1 , Yanhua Sha  2 , Bailin Wang  1
Affiliations

Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

Yong Yan et al. Front Oncol. .

Abstract

Objective: This meta-analysis compares the perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to those of open pancreaticoduodenectomy (OPD) for pancreatic and periampullary tumors.

Background: LPD has been increasingly applied in the treatment of pancreatic and periampullary tumors. However, the perioperative outcomes of LPD versus OPD are still controversial.

Methods: PubMed, Web of Science, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials (RCTs) and non-randomized comparative trials (NRCTs) comparing LPD versus OPD for pancreatic and periampullary tumors. The main outcomes were mortality, morbidity, serious complications, and hospital stay. The secondary outcomes were operative time, blood loss, transfusion, postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), bile leak (BL), delayed gastric emptying (DGE), lymph nodes harvested, R0 resection, reoperation, and readmission. RCTs were evaluated by the Cochrane risk-of-bias tool. NRCTs were assessed using a modified tool from the Methodological Index for Non-randomized Studies. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42022338832).

Results: Four RCTs and 35 NRCTs concerning a total of 40,230 patients (4,262 LPD and 35,968 OPD) were included. Meta-analyses showed no significant differences in mortality (OR 0.91, p = 0.35), serious complications (OR 0.97, p = 0.74), POPF (OR 0.93, p = 0.29), PPH (OR 1.10, p = 0.42), BL (OR 1.28, p = 0.22), harvested lymph nodes (MD 0.66, p = 0.09), reoperation (OR 1.10, p = 0.41), and readmission (OR 0.95, p = 0.46) between LPD and OPD. Operative time was significantly longer for LPD (MD 85.59 min, p < 0.00001), whereas overall morbidity (OR 0.80, p < 0.00001), hospital stay (MD -2.32 days, p < 0.00001), blood loss (MD -173.84 ml, p < 0.00001), transfusion (OR 0.62, p = 0.0002), and DGE (OR 0.78, p = 0.002) were reduced for LPD. The R0 rate was higher for LPD (OR 1.25, p = 0.001).

Conclusions: LPD is associated with non-inferior short-term surgical outcomes and oncologic adequacy compared to OPD when performed by experienced surgeons at large centers. LPD may result in reduced overall morbidity, blood loss, transfusion, and DGE, but longer operative time. Further RCTs should address the potential advantages of LPD over OPD.

Systematic review registration: PROSPERO, identifier CRD42022338832.

Keywords: laparoscopic pancreaticoduodenectomy; meta-analysis; open pancreaticoduodenectomy; pancreatic head; periampullary tumor; whipple.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Forest plot of comparison between LPD and OPD on postoperative mortality. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 2
Figure 2
Forest plot of comparison between LPD and OPD on overall postoperative complications. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 3
Figure 3
Forest plot of comparison between LPD and OPD on serious postoperative complications. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 4
Figure 4
Forest plot of comparison between LPD and OPD on hospital stay. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 5
Figure 5
Forest plot of comparison between LPD and OPD on operative time. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 6
Figure 6
Forest plot of comparison between LPD and OPD on estimated blood loss. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 7
Figure 7
Forest plot of comparison between LPD and OPD on intraoperative blood transfusion. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 8
Figure 8
Forest plot of comparison between LPD and OPD on postoperative pancreatic fistula. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 9
Figure 9
Forest plot of comparison between LPD and OPD on postpancreatectomy hemorrhage. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 10
Figure 10
Forest plot of comparison between LPD and OPD on bile leak. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 11
Figure 11
Forest plot of comparison between LPD and OPD on delayed gastric emptying. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 12
Figure 12
Forest plot of comparison between LPD and OPD on harvested lymph nodes. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
Figure 13
Figure 13
Forest plot of comparison between LPD and OPD on R0 resection. LPD, laparoscopic pancreaticoduodenectom; OPD, open pancreaticoduodenectomy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Farges O, Bendersky N, Truant S, Delpero JR, Pruvot FR, Sauvanet A, et al. . The theory and practice of pancreatic surgery in France. Ann Surg (2017) 266:797–804. doi: 10.1097/SLA.0000000000002399 - DOI - PubMed
    1. Balzano G, Guarneri G, Pecorelli N, Paiella S, Rancoita PMV, Bassi C, et al. . Modelling centralization of pancreatic surgery in a nationwide analysis. Br J Surg (2020) 107:1510–9. doi: 10.1002/bjs.11716 - DOI - PubMed
    1. Strobel O, Neoptolemos J, Jäger D, Büchler MW. Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol (2019) 16:11–26. doi: 10.1038/s41571-018-0112-1 - DOI - PubMed
    1. Polonski A, Izbicki JR, Uzunoglu FG. Centralization of pancreatic surgery in Europe. J Gastrointest Surg (2019) 23:2081–92. doi: 10.1007/s11605-019-04215-y - DOI - PubMed
    1. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. . Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg (2020) 15:27. doi: 10.1186/s13017-020-00306-3 - DOI - PMC - PubMed

Publication types

LinkOut - more resources