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Open Access 01-08-2017 | Systematic Reviews and Meta-analyses

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

Authors: Michał Pędziwiatr, Piotr Małczak, Magdalena Pisarska, Piotr Major, Michał Wysocki, Tomasz Stefura, Andrzej Budzyński

Published in: Langenbeck's Archives of Surgery | Issue 5/2017

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.

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Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410CrossRefPubMed

Lassen K, Coolsen MME, Slim K et al (2012) Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 37:240–258. doi:10.1007/s00268-012-1771-1 CrossRef

Correa-Gallego C, Dinkelspiel HE, Sulimanoff I et al (2014) Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 218:129–139. doi:10.1016/j.jamcollsurg.2013.09.005 CrossRefPubMed

Song KB, Kim SC, Hwang DW et al (2015) Matched case-control analysis comparing laparoscopic and open pylorus-preserving pancreaticoduodenectomy in patients with periampullary tumors. Ann Surg 262:146–155. doi:10.1097/SLA.0000000000001079 CrossRefPubMed

Wellner UF, Küsters S, Sick O et al (2014) Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbeck’s Arch Surg 399:849–856. doi:10.1007/s00423-014-1236-0 CrossRef

Mendoza AS III, Han H-S, Yoon Y-S et al (2015) Laparoscopy-assisted pancreaticoduodenectomy as minimally invasive surgery for periampullary tumors: a comparison of short-term clinical outcomes of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 22:819–824. doi:10.1002/jhbp.289 CrossRefPubMed

Wang Y, Bergman S, Piedimonte S, Vanounou T (2014) Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach. Can J Surg 57:263–270. doi:10.1503/cjs.026713 CrossRefPubMedPubMedCentral

Walsh RM, Chalikonda S (2016) How I do it: hybrid laparoscopic and robotic pancreaticoduodenectomy. J Gastrointest Surg 20:1650–1657. doi:10.1007/s11605-016-3170-7 CrossRefPubMed

Inoue Y, Saiura A, Sato T et al (2016) Laparoscopic pancreatoduodenectomy combined with a novel self-assessment system and feedback discussion: a phase 1 surgical trial following the IDEAL guidelines. Langenbeck’s Arch Surg 401:1123–1130. doi:10.1007/s00423-016-1466-4 CrossRef

10.

Arezzo A, Passera R, Salvai A et al (2015) Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature. Surg Endosc 29:334–348. doi:10.1007/s00464-014-3686-4 CrossRefPubMed

11.

Quan Y, Huang A, Ye M et al (2016) Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 19:939–950. doi:10.1007/s10120-015-0516-x CrossRefPubMed

12.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(xi):564. doi:10.1186/1471-2288-5-13

13.

Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012

14.

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. doi:10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

15.

Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg 215:810–819. doi:10.1016/j.jamcollsurg.2012.08.006 CrossRefPubMed

16.

Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ (2013) Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc 27:4518–4523. doi:10.1007/s00464-013-3101-6 CrossRefPubMed

17.

Stauffer JA, Coppola A, Villacreses D et al (2016) Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc. doi:10.1007/s00464-016-5222-1 PubMed

18.

Gumbs AA, Grès P, Madureira FA, Gayet B (2008) Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg 12:707–712. doi:10.1007/s11605-007-0311-z CrossRefPubMed

19.

Baker EH, Ross SW, Seshadri R et al (2016) Robotic pancreaticoduodenectomy: comparison of complications and cost to the open approach. Int J Med Rob Comput Assisted Surg 12:554–560. doi:10.1002/rcs.1688 CrossRef

20.

Bao PQ, Mazirka PO, Watkins KT (2014) Retrospective comparison of robot-assisted minimally invasive versus open pancreaticoduodenectomy for periampullary neoplasms. J Gastrointest Surg 18:682–689. doi:10.1007/s11605-013-2410-3 CrossRefPubMed

21.

Boggi U, Napoli N, Costa F et al (2016) Robotic-assisted pancreatic resections. World J Surg 40:2497–2506. doi:10.1007/s00268-016-3565-3 CrossRefPubMed

22.

Buchs NC, Addeo P, Bianco FM et al (2011) Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 35:2739–2746. doi:10.1007/s00268-011-1276-3 CrossRefPubMed

23.

Chen S, Chen J-Z, Zhan Q et al (2015) Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 29:3698–3711. doi:10.1007/s00464-015-4140-y CrossRefPubMed

24.

Lai ECH, George PCY, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy—a comparative study. Int J Surg 10:475–479. doi:10.1016/j.ijsu.2012.06.003 CrossRefPubMed

25.

Zhou NX, Chen JZ, Liu Q et al (2011) Outcomes of pancreatoduodenectomy with robotic surgery versus open surgery. Int J Med Rob Comput Assisted Surg 7:131–137. doi:10.1002/rcs.380 CrossRef

26.

Zureikat AH, Postlewait LM, Liu Y et al (2016) A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Ann Surg 264:640–649. doi:10.1097/SLA.0000000000001869 CrossRefPubMed

27.

Croome KP, Farnell MB, Que FG et al (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Ann Surg 260:633–640. doi:10.1097/SLA.0000000000000937 CrossRefPubMed

28.

Delitto D, Luckhurst CM, Black BS et al (2016) Oncologic and perioperative outcomes following selective application of laparoscopic pancreaticoduodenectomy for periampullary malignancies. J Gastrointest Surg 20:1343–1349. doi:10.1007/s11605-016-3136-9 CrossRefPubMed

29.

Tan C-L, Zhang H, Peng B, Li K-Z (2015) Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol 21:5311–5319. doi:10.3748/wjg.v21.i17.5311 CrossRefPubMedPubMedCentral

30.

Zureikat AH, Breaux JA, Steel JL, Hughes SJ (2011) Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg 15:1151–1157. doi:10.1007/s11605-011-1530-x CrossRefPubMed

31.

Giulianotti PC, Sbrana F, Bianco FM et al (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657. doi:10.1007/s00464-009-0825-4 CrossRefPubMed

32.

de Rooij T, Klompmaker S, Abu Hilal M et al (2016) Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol 13:227–238. doi:10.1038/nrgastro.2016.17 CrossRefPubMed

33.

Coppola A, Stauffer JA, Asbun HJ (2016) Laparoscopic pancreatoduodenectomy: current status and future directions. Updat Surg 68:217–224. doi:10.1007/s13304-016-0402-z CrossRef

34.

Zhang H, Wu X, Zhu F et al (2016) Systematic review and meta-analysis of minimally invasive versus open approach for pancreaticoduodenectomy. Surg Endosc 30:5173–5184. doi:10.1007/s00464-016-4864-3 CrossRefPubMed

35.

Wang M, Cai H, Meng L et al (2016) Minimally invasive pancreaticoduodenectomy: a comprehensive review. Int J Surg 35:139–146. doi:10.1016/j.ijsu.2016.09.016 CrossRefPubMed

36.

Qin H, Qiu J, Zhao Y et al (2014) Does minimally-invasive pancreaticoduodenectomy have advantages over its open method? A meta-analysis of retrospective studies. PLoS One 9:e104274. doi:10.1371/journal.pone.0104274 CrossRefPubMedPubMedCentral

37.

Speicher PJ, Nussbaum DP, White RR et al (2014) Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol 21:4014–4019. doi:10.1245/s10434-014-3839-7 CrossRefPubMed

38.

Boone BA, Zenati M, Hogg ME et al (2015) Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg 150:416–422. doi:10.1001/jamasurg.2015.17 CrossRefPubMed

39.

Napoli N, Kauffmann EF, Palmeri M et al (2016) The learning curve in robotic pancreaticoduodenectomy. Dig Surg 33:299–307. doi:10.1159/000445015 CrossRefPubMed

40.

Petermann D, Demartines N, Schäfer M (2013) Is tumour size an underestimated feature in the current TNM system for malignancies of the pancreatic head? HPB (Oxford) 15:872–881. doi:10.1111/hpb.12052 CrossRef

41.

Marchegiani G, Andrianello S, Malleo G et al (2016) Does size matter in pancreatic cancer?: reappraisal of tumour dimension as a predictor of outcome beyond the TNM. Ann Surg 1. doi:10.1097/SLA.0000000000001837 PubMedCentral

42.

Esposito I, Kleeff J, Bergmann F et al (2008) Most pancreatic cancer resections are R1 resections. Ann Surg Oncol 15:1651–1660. doi:10.1245/s10434-008-9839-8 CrossRefPubMed

43.

Verbeke C, Löhr M, Karlsson JS, Del Chiaro M (2015) Pathology reporting of pancreatic cancer following neoadjuvant therapy: challenges and uncertainties. Cancer Treat Rev 41:17–26. doi:10.1016/j.ctrv.2014.11.002 CrossRefPubMed

44.

Verbeke CS, Gladhaug IP (2012) Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg 99:1036–1049. doi:10.1002/bjs.8734 CrossRefPubMed

45.

Hackert T, Werner J, Weitz J et al (2010) Uncinate process first—a novel approach for pancreatic head resection. Langenbeck’s Arch Surg 395:1161–1164. doi:10.1007/s00423-010-0663-9 CrossRef

46.

Witzigmann H, Diener MK, Kienkötter S et al (2016) No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg 264:528–537. doi:10.1097/SLA.0000000000001859 CrossRefPubMed

47.

Sanjay P, Takaori K, Govil S et al (2012) “Artery-first” approaches to pancreatoduodenectomy. Br J Surg 99:1027–1035. doi:10.1002/bjs.8763 CrossRefPubMed

Title: Minimally invasive versus open pancreatoduodenectomy—systematic review and meta-analysis
Authors: Michał Pędziwiatr
Piotr Małczak
Magdalena Pisarska
Piotr Major
Michał Wysocki
Tomasz Stefura
Andrzej Budzyński
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 5/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1583-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methodology

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methodology

Results

Conclusion

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