Abstract
BackgroundWhile more and more open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Therefore, we carried out this meta-analysis to evaluate whether MIPD is safe, feasible and worthwhile.MethodsPubMed, EMBASE, and Cochrane Library were searched to identify studies published between January 1994 and November 2013 comparing MIPD with open pancreaticoduodenectomy (OPD). Intraoperative outcomes, oncologic safety, postoperative complications, and postoperative recovery were evaluated.Results11 retrospective studies representing 869 patients (327 MIPDs, 542 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (MD −361.93 ml, 95% CI −519.22 to −204.63 ml, p<0.001, I2 = 94%), wound infection (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007, I2 = 0%), and hospital stay (MD −2.64 d, 95% CI −4.23 to −1.05 d, p = 0.001, I2 = 78%). However, it brings longer operative time (MD 105 min, 95% CI 49.73 to 160.26 min, p<0.001, I2 = 93%). There were no significant differences between the two procedures in likelihood of overall complications (p = 0.05), pancreatic fistula (PF) (p = 0.86), delayed gastric empting (DGE) (p = 0.96), positive surgical margins (p = 0.07), retrieval of lymph nodes (p = 0.48), reoperation (p = 0.16) and mortality (p = 0.64).ConclusionsOur results suggest that MIPD is currently safe, feasible and worthwhile. But considering the selection bias, complexity of MIPD and lack of long-term oncologic outcomes, we suggest it be performed in a high-volume pancreatic surgery center in selected patients.
Highlights
Laparoscopy has become widely accepted in many intraabdominal surgeries and has proved to be beneficial to patients in terms of postoperative recovery, reduction of complications and hospital stay [1,2,3,4,5] on various occasions
Continuous variables was conducted with the Inverse-Variance statistical method by using weighted mean difference (MD), and dichotomous variables were analyzed with the Mantel-Haenszel statistical method using odds ratio (OR) as the summary statistic, and both were reported with 95% confidence intervals (CI)
In phase 1 of the study selection process, 19 potential eligible articles were included for a full-text version after screening their titles and abstracts
Summary
Laparoscopy has become widely accepted in many intraabdominal surgeries and has proved to be beneficial to patients in terms of postoperative recovery, reduction of complications and hospital stay [1,2,3,4,5] on various occasions. Laparoscopic cholecystectomy has even become the gold standard for surgical removal of the gallbladder. MIPD is still not universally practiced, because the complexity of the procedure has questioned the safety and advantages over its open counterpart. With the maturation of surgeons’ laparoscopic skills and advances in technology, including surgical robotics, MIPD received more interest. A large number of single-institution series of MIPD have been performed and a variety of studies have been reported [6,7,8,9,10]. There is currently no powerful evidence that informs the advantages of using laparoscopy over conventional OPD. While more and more open procedures routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. We carried out this meta-analysis to evaluate whether MIPD is safe, feasible and worthwhile
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
