Laparoscopic versus open pancreatoduodenectomy for periampullary tumors: An updated systematic review and meta-analysis.

Abstract

e16362 Background: Laparoscopic pancreatoduodenectomy (LPD) has emerged as an alternative to open technique in treating periampullary tumors, particularly pancreatic ductal adenocarcinoma (PDAC). However, the evidence regarding safety and efficacy of LPD compared to open pancreatoduodenectomy (OPD) remains unclear. Methods: According to PRISMA guidelines, we searched PubMed, Embase, and Cochrane Library in December 2023 for randomized controlled trials (RCTs) that directly compare LPD versus OPD in patients with periampullary tumors. Outcomes were stratified as intraoperative outcomes, postoperative complications, in-hospital and short-term, and prespecified subanalysis was performed in patients with PDAC. All statistical analysis was performed using R software version 4.3.1 with a random-effects model. Results: Five RCTs yielding 1,018 patients with periampullary tumors were included, of whom 511 (50.2%) were randomized to LPD group. The total follow-up time was 90 days. LPD was associated with a longer operation time (MD 66.75; 95% CI 26.59 to 106.92; p = 0.001; I2= 87%; Figure 1A), lower intraoperative blood loss (MD -124.05; 95% CI -178.56 to -69.53; p < 0.001; I2= 86%; Figure 1B), and shorter length of stay (MD -1.37; 95% IC -2.31 to -0.43; p = 0.004; I2= 14%; Figure 1C) as compared to OPD. In terms of 90-day mortality rates and number of lymph nodes yield, no significant differences were found between both groups. Subgroup analysis for PDAC consistently aligned with the overall results and provided relatively lower heterogeneity compared to the primary analysis. Conclusions: Our meta-analysis of RCTs suggests that LPD is an effective and safe alternative for patients with periampullary tumors, with lower intraoperative blood loss and shorter length of stay.