Abstract
The feasible of minimally invasive pancreaticoduodenectomy (MIPD) remains controversial when compared with open pancreaticoduodenectomy (OPD). We conducted a systemic review and meta-analysis to summarise the available evidence to compare MIPD vs OPD. We systemically searched PubMed, EMBASE and Web of Science for studies published through February 2016. The primary endpoint was postoperative pancreatic fistula (POPF, grade B/C). A total of 27 studies involving 14,231 patients (2,377 MIPD and 11,854 OPD) were included. MIPD was associated with longer operative times (P < 0.01) and increased mortality (P < 0.01), but decreased estimated blood loss (P < 0.01), decreased delayed gastric emptying (P < 0.01), increased R0 resection rate (P < 0.01), decreased wound infection (P = 0.03) and shorter hospital stays (P < 0.01). There were no significant differences in BMI (P = 0.43), tumor size (P = 0.17), lymph nodes harvest (P = 0.57), POPF (P = 0.84), reoperation (P = 0.25) and 5-year survival rates (P = 0.82) for MIPD compared with OPD. Although there was an increased operative cost (P < 0.01) for MIPD compared with OPD, the postoperative cost was less (P < 0.01) with the similar total costs (P = 0.28). MIPD can be a reasonable alternative to OPD with the potential advantage of being minimally invasive. However, MIPD should be performed in high-volume centers and more randomized-controlled trials are needed to evaluate the appropriate indications of MIPD.
Highlights
Invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is considered to be one of the most challenging laparoscopic surgeries
We conducted a systematic analysis based on more sufficient evidence and a quantitative synthesis of the eligible data with the following objectives: (1) to provide an update with more sufficient evidence published up to February 2016 on the comparison between minimally invasive pancreaticoduodenectomy (MIPD) and open pancreaticoduodenectomy (OPD); (2) to further examine the comparison between the type of MIPD and OPD according to subgroup analyses including the type of MIPD, geographic area, sample size, publication year and quality score; and (3) to examine the cost and 5-year survival rate to estimate the burden of cost and long-term survival rate associated with MIPD compared with OPD
The results showed that the operative times were longer for MIPD (WMD = 67.37 minutes, 95% confidence intervals (CIs) = 25.11–109.63 minutes, P < 0.01), but that there was less estimated blood loss (WMD = −324.47 mL, 95% CI = −492.37, −156.57 mL, P < 0.01) and an increased R0 resection rate (OR = 1.40, 95% CI = 1.15–1.70, P < 0.01) with no significant differences in lymph nodes harvest (WMD = 0.36, 95% CI = −0.81–1.61, P = 0.57)
Summary
Laparoscopic or robotic pancreatectomy without pancreaticoduodenectomy was excluded Study quality in this meta-analysis was assessed using the Newcastle-Ottawa Scale (NOS)[12]. The NOS was judged in three parts, including the elucidation of exposure or the outcomes of interest for case-control or cohort studies, the selection of the study populations and the comparability of the populations. A data extraction sheet was established to enter the data from each study, including the first author, year of publication, country, study type, study period, study centers, study population, cancer diagnosis, type of MIPD, mortality and NOS score (Table 1). Subgroup analyses were conducted to further explore the sources of heterogeneity by type of MIPD, geographic area, sample size, publication year and quality score (P < 0.1 was considered to be a significant source of heterogeneity). Sensitivity analyses were conducted to investigate the influence of a specific study on the pooled risk estimate by removing one study in each turn
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