Abstract
BackgroundThe aim of this study was to compare the oncological outcomes and clinical efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsWe systematically searched PubMed, EMBASE, Web of Science, ClinicalTrials.gov and the Cochrane Central Register for studies published between May 1998 and May 2018. The included studies compared LPD and OPD for the treatment of PDAC. The oncological outcomes and perioperative data were analyzed.ResultsEight studies involving 15,278 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS) between patients undergoing the two types of surgery (HR: 0.97, 95% CI 0.82–1.15, p = 0.76). LPD resulted in a higher rate of R0 resection than OPD (OR: 1.16, 95% CI 0.85–1.57, p > 0.05). This study showed that compared with OPD, LPD resulted in comparable rates of postoperative pancreatic fistulas (POPFs) (OR: 1.07, 95% CI: 0.68–1.68, p = 0.77) and postoperative hemorrhage (OR: 1.74, 95% CI 0.96–3.71, p = 0.07), more harvested lymph nodes (WMD: 1.84, 95% CI: 0.95–2.72, p < 0.05), shorter hospital stays (WMD: -2.45, 95% CI: − 3.33- -1.56, p < 0.05), and less estimated blood loss (WMD: -374.30, 95% CI: − 513.06- -235.54, p < 0.05).ConclusionsLPD is equivalent to OPD with respect to 5-year OS and results in better perioperative clinical outcomes for patients with PDAC.
Highlights
The aim of this study was to compare the oncological outcomes and clinical efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with pancreatic ductal adenocarcinoma (PDAC)
No significant difference was found in the 5-year overall survival (OS) between patients undergoing the two types of surgery (HR: 0.97, 95% Confidence interval (CI) 0.82–1.15, p = 0.76)
LPD resulted in a higher rate of R0 resection than OPD (OR: 1.16, 95% CI 0.85–1.57, p > 0.05)
Summary
The aim of this study was to compare the oncological outcomes and clinical efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with pancreatic ductal adenocarcinoma (PDAC). Pancreaticoduodenectomy (PD) is the main therapy for resectable and borderline resectable pancreatic ductal adenocarcinoma (PDAC) [1]. Studies have addressed the efficacy and safety of LPD and OPD. Studies have shown that LPD results in better visual magnification, better exposure, and more delicate manipulation of the deep and difficult to reach tissues. Recent studies have reported that LPD can achieve the same oncological outcomes as OPD. Conrad et al performed a retrospective study involving 65 patients and found that LPD was noninferior to OPD with respect to long-term outcomes for patients with PDAC [4]
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