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World Journal of Surgery
Published in: World Journal of Surgery 3/2018

01-03-2018 | Original Scientific Report

Minimally Invasive Pancreaticoduodenectomy: What is the Best “Choice”? A Systematic Review and Network Meta-analysis of Non-randomized Comparative Studies

Authors: Claudio Ricci, Riccardo Casadei, Giovanni Taffurelli, Carlo Alberto Pacilio, Marco Ricciardiello, Francesco Minni

Published in: World Journal of Surgery | Issue 3/2018

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Abstract

Background

Many mini-invasive pancreaticoduodenectomy (MIPD) techniques have been reported, but their advantages with respect to an open technique (OPD) and with respect to each other are unclear.

Method

A systematic literature search of studies comparing different types of MIPD was carried out: laparoscopic-assisted (LAPD), totally robotic (TRPD), totally laparoscopic (TLPD) or totally laparoscopic—robotic assisted (TLPD-RA) to OPD. The primary endpoint was postoperative mortality. The secondary endpoints were intraoperative, postoperative and oncological outcomes. A network meta-analysis was designed to generate direct, indirect and mixed estimate effects, between different approaches, for each variable. The effects were reported as pairwise comparisons and hierarchical ranking as to each approach could be the best or the worst for each outcome, expressed by the surface under the cumulative ranking curve.

Results

Twenty studies were identified, involving 2759 patients: 1813 OPDs, 81 LAPDs, 505 TRPDs, 224 TLPDs and 136 TLPD-RAs. No differences regarding postoperative mortality were found in pairwise comparison. The LAPD technique had a high probability of being the worst approach, while TRPD had a high probability of being one of the best. Regarding the secondary endpoints, OPD was the best regarding operative time and postoperative bleeding, but the worst regarding blood loss and wound infection. The TRPD or TLPD-RA techniques seemed to be the best for delayed gastric emptying, length of hospital stay, harvested lymph nodes and postoperative morbidity. The TLPD technique was often the worst approach, especially for overall and major complications, postoperative bleeding and biliary leak.

Conclusion

The safest MIPDs are those involving a robotic system which seems to have a promising role in ameliorating the outcomes of OPD, especially when compared to a laparoscopic approach.
Appendix
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Literature
1.
Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410CrossRefPubMed
2.
Wang M, Cai H, Meng L et al (2016) Minimally invasive pancreaticoduodenectomy: a comprehensive review. Int J Surg 35:139–146CrossRefPubMed
3.
Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci 20:421–428CrossRefPubMed
4.
Nigri G, Petrucciani N, La Torre M et al (2014) Duodenopancreatectomy: open or minimally invasive approach? Surgeon 12:227–234CrossRefPubMed
5.
Lei P, Wei B, Guo W et al (2014) Minimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety. Surg Laparosc Endosc Percutan Tech 24:296–305CrossRefPubMed
6.
Zhang J, Wu WM, You L et al (2013) Robotic versus open pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol 20:1774–1780CrossRefPubMed
7.
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 13(9):e104274CrossRef
8.
Correa-Gallego C, Dinkelspiel HE, Sulimanoff I et al (2014) Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 218:129–139CrossRefPubMed
9.
Doula C, Kostakis ID, Damaskos C et al (2016) Comparison between minimally invasive and open pancreaticoduodenectomy: a systematic review. Surg Laparosc Endosc Percutan Tech 26:6–16CrossRefPubMed
10.
Peng L, Lin S, Li Y et al. (2016) Systematic review and meta-analysis of robotic vs. open pancreaticoduodenectomy. Surg Endosc [Epub ahead of print]
11.
Shin SH, Kim YJ, Song KB et al. (2016) Totally laparoscopic or robot-assisted pancreaticoduodenectomy versuss open surgery for periampullary neoplasms: separate systematic reviews and meta-analyses. Surg Endosc [Epub ahead of print]
12.
Zhang H, Wu X, Zhu F et al (2016) Systematic review and meta-analysis of minimally invasive vs. open approach for pancreaticoduodenectomy. Surg Endosc 30:5173–5184CrossRefPubMed
13.
Cipriani A, Higgins JP, Geddes JR et al (2013) Conceptual and technical challenges in network meta-analysis. Ann Intern Med 16(159):130–137CrossRef
14.
Higgins JP, Green S, Collaboration C (2008) Cochrane handbook for systematic reviews of interventions: Wiley Online Library
15.
Hutton B, Salanti G, Caldwell DM et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 11:777–784CrossRef
16.
Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomised studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefPubMed
17.
Swanson RS, Pezzi CM, Mallin K et al (2014) The 90-day mortality after pancreatectomy for cancer is double the 30-day mortality: more than 20,000 resections from the national cancer data base. Ann Surg Oncol 21:4059–4067CrossRefPubMed
18.
19.
Mills EJ, Ioannidis JP, Thorlund K et al (2012) How to use an article reporting a multiple treatment comparison meta-analysis. JAMA 26(308):1246–1253CrossRef
20.
21.
Salanti G, Ades AE (2011) Ioannidis JP Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 64:163–171CrossRefPubMed
22.
White IR, Barrett JK, Jackson D et al (2012) Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression. Res Synth Methods 3:111–125CrossRefPubMedPubMedCentral
23.
Bucher HC, Guyatt GH, Griffith LE et al (1997) The results of direct and indirect treatment comparisons in meta-analysis of randomised controlled trials. J Clin Epidemiol 50:683–691CrossRefPubMed
24.
Turner RM, Davey J, Clarke MJ et al (2012) Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane Database of Systematic Reviews. Int J Epidemiol 41:818–827CrossRefPubMedPubMedCentral
25.
26.
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 215:810–819CrossRefPubMed
27.
Senthilnathan P, Chinnusamy P, Ramanujam A et al (2015) Comparison of pathological radicality between open and laparoscopic pancreaticoduodenectomy in a tertiary centre. Indian J Surg Oncol 6:20–25CrossRefPubMedPubMedCentral
28.
Shubert CR, Wagie AE, Farnell MB et al (2015) Clinical risk score to predict pancreatic fistula after pancreaticoduodenectomy: independent external validation for open and laparoscopic approaches. J Am Coll Surg 3:689–698CrossRef
29.
Mesleh MG, Stauffer JA, Bowers SP et al (2013) Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc 27:4518–4523CrossRefPubMed
30.
Adam MA, Choudhury K, Dinan MA et al (2015) minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg 262:372–377CrossRefPubMed
31.
Stauffer JA, Coppola A, Villacreses D et al. (2016) Laparoscopic vs open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc [Epub ahead of print]
32.
Croome KP, Farnell MB, Que FG et al (2015) Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg 19:189–194CrossRefPubMed
33.
Sharpe SM, Talamonti MS, Wang CE et al (2015) Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg 221:175–184CrossRefPubMed
34.
Girgis MD, Zenati MS, Steve J et al. (2016) Robotic approach mitigates perioperative morbidity in obese patients following pancreaticoduodenectomy HPB (Oxford) [Epub ahead of print]
35.
Wei H, Wei B, Zheng Z et al (2014) Comparative study of outcomes after laparoscopic vs. open pancreaticoduodenectomy. Zhonghua Wei Chang Wai Ke Za Zhi 17:465–468PubMed
36.
Li YB, Wang X, Wang MJ et al (2013) Delayed gastric emptying after laparoscopic versus open pancreaticoduodenectomy: a comparative study. Zhonghua Wai Ke Za Zhi. 51:304–307PubMed
37.
Cho A, Yamamoto H, Nagata M et al (2009) Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 198:445–449CrossRefPubMed
38.
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. CrossRefPubMed
39.
Zhou NX, Chen JZ, Liu Q et al (2011) Outcomes of pancreatoduodenectomy with robotic surgery vs. open surgery. Int J Med Robot 7:131–137CrossRefPubMed
40.
Zureikat AH, Breaux JA, Steel JL et al (2011) Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg 15:1151–1157CrossRefPubMed
41.
Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402CrossRefPubMed
42.
Kuroki T, Adachi T, Okamoto T et al (2012) A non-randomised comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepatogastroenterology 59:570–573CrossRefPubMed
43.
Lai EC, Yang GP, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy–a comparative study. Int J Surg 10:475–479CrossRefPubMed
44.
Bao PQ, Mazirka PO, Watkins KT (2014) Retrospective comparison of robot-assisted minimally invasive vs. open pancreaticoduodenectomy for periampullary neoplasms. J Gastrointest Surg 18:682–689CrossRefPubMed
45.
Croome KP, Farnell MB, Que FG et al (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–638CrossRefPubMed
46.
Hakeem AR, Verbeke CS, Cairns A et al (2014) A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using leeds pathology protocol. Hepatobiliary Pancreat Dis Int 13:435–441CrossRefPubMed
47.
Langan RC, Graham JA, Chin AB et al (2014) Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures. Surgery 156:379–384CrossRefPubMed
48.
Chen S, Chen JZ, Zhan Q et al (2015) Robot-assisted laparoscopic vs. open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 29:3698–3711CrossRefPubMed
49.
Dokmak S, Ftériche FS, Aussilhou B et al (2015) Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg 220:831–838CrossRefPubMed
50.
Mendoza AS 3rd, Han HS, Yoon YS 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 22:819–824CrossRefPubMed
51.
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 262:146–155CrossRefPubMed
52.
Tan CL, Zhang H, Peng B et al (2015) Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol 21:5311–5319CrossRefPubMedPubMedCentral
53.
Baker EH, Ross SW, Seshadri R et al (2016) Robotic pancreaticoduodenectomy: comparison of complications and cost to the open approach. Int J Med Robot 12:554–560CrossRefPubMed
54.
Liu R, Zhang T, Zhao ZM, et al. (2016) The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center. Surg Endosc [Epub ahead of print]
55.
Zureikat AH, Postlewait LM, Liu Y et al (2016) A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Ann Surg 264:640–649CrossRefPubMed
56.
Boggi U, Napoli N, Costa F et al (2016) Robotic-assisted pancreatic resections. World J Surg 40:2497–2506. CrossRefPubMed
57.
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed
58.
Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768CrossRefPubMed
59.
Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy haemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25CrossRefPubMed
60.
Wright GP, Zureikat AH (2016) Development of minimally invasive pancreatic surgery: an evidence-based systematic review of laparoscopic vs robotic approaches. J Gastrointest Surg 8:784–791CrossRef
61.
Ito M, Horiguchi A, Ishihara S et al (2009) Laparoscopic pancreatic surgery: totally laparoscopic pancreatoduodenectomy and reconstruction. Pancreas 38:1009CrossRef
62.
Wang Y, Bergman S, Piedimonte S et al (2014) Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach. Can J Surg 57:263–270CrossRefPubMedPubMedCentral
63.
Yun L, Qian Z, Chenghong P (2014) Analysis of the relevant factors of pancreatic fistula after robot assisted pancreatic surgery. J Hepatobiliary Surg 22:15–19
64.
van Heek NT, Kuhlmann KF, Scholten RJ et al (2005) Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 242:781–790CrossRefPubMedPubMedCentral
65.
Benlice C, Costedio M, Stocchi L et al (2016) Hand-assisted laparoscopic vs open colectomy: an assessment from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted cohort. Am J Surg 212:808–813CrossRefPubMed
66.
Farid S, Morris-Stiff G (2013) Laparoscopic vs open pancreaticoduodenectomy. J Am Coll Surg 216:1220–1221CrossRefPubMed
67.
de la Fuente SG (2013) Laparoscopic pancreaticoduodenectomies: a word of caution. J Am Coll Surg 216:1218CrossRefPubMed
68.
Boggi U, Signori S, De Lio N et al (2013) Feasibility of robotic pancreaticoduodenectomy. Br J Surg 100:917–925CrossRefPubMed
69.
Casadei R, Ricci C, Taffurelli G et al (2015) Are there preoperative factors related to a “soft pancreas” and are they predictive of pancreatic fistulas after pancreatic resection? Surg Today 45:708–714CrossRefPubMed
Metadata
Title
Minimally Invasive Pancreaticoduodenectomy: What is the Best “Choice”? A Systematic Review and Network Meta-analysis of Non-randomized Comparative Studies
Authors
Claudio Ricci
Riccardo Casadei
Giovanni Taffurelli
Carlo Alberto Pacilio
Marco Ricciardiello
Francesco Minni
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 3/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4180-7

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