Perioperative and oncological outcomes following minimally invasive versus open pancreaticoduodenectomy for pancreatic duct adenocarcinoma

Rui Sun,Xianlin Han,Zhika Liang,Yifan Zhang,Jiawen Yu

doi:10.1007/s00464-020-07641-1

Abstract

BackgroundThe outcomes of minimally invasive pancreaticoduodenectomy have not been adequately compared with those of open pancreaticoduodenectomy in patients with pancreatic ductal adenocarcinoma. We performed a meta‐analysis to compare the perioperative and oncological outcomes of these two pancreaticoduodenectomy procedures specifically in patients with pancreatic ductal adenocarcinoma.MethodsBefore this study was initiated, a specific protocol was designed and has been registered in PROSEPRO (ID: CRD42020149438). Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, PubMed, EMBASE, Web of Science, Cochrane Central Register, and ClinicalTrials.gov databases were systematically searched for studies published between January 1994 and October 2019. Overall survival, disease-free survival, and time to commencing adjuvant chemotherapy were the primary endpoint measurements, whereas perioperative and short-term outcomes were the secondary endpoints.ResultsThe final analysis included 9 retrospective cohorts comprising 11,242 patients (1377 who underwent minimally invasive pancreaticoduodenectomy and 9865 who underwent open pancreaticoduodenectomy). There were no significant differences in the patients’ overall survival, operative time, postoperative complications, 30-day mortality, rate of vein resection, number of harvested lymph nodes, or rate of positive lymph nodes between the two approaches. However, disease-free survival, time to starting adjuvant chemotherapy, length of hospital stay, and rate of negative margins in patients who underwent minimally invasive pancreaticoduodenectomy showed improvements relative to those in patients who underwent open surgery.ConclusionsMinimally invasive pancreaticoduodenectomy provides similar or even improved perioperative, short-term, and long-term oncological outcomes when compared with open pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma.

Highlights

The outcomes of minimally invasive pancreaticoduodenectomy have not been adequately compared with those of open pancreaticoduodenectomy in patients with pancreatic ductal adenocarcinoma
Three studies [15, 21, 23] comprising a total of 913 patients (228 underwent minimally invasive PD (MIPD) and 685 underwent open PD (OPD)) provided data on vein resection; our analysis revealed no difference in the vein resection rate (RR = 0.96; 95% confidence interval (CI) 0.76 to 1.20; P = 0.71, I2 = 0%) (Fig. 4A)
We found that the R0 resection rate was higher in the MIPD group, with low heterogeneity as shown in a random effects model (RR = 1.06; 95% CI 1.01 to 1.12; P = 0.02, I2 = 36%) (Fig. 4B)

Summary

Introduction

The outcomes of minimally invasive pancreaticoduodenectomy have not been adequately compared with those of open pancreaticoduodenectomy in patients with pancreatic ductal adenocarcinoma. Two investigators independently extracted the following information: first author, year of publication, study type, mean age, population size, tumor size, and main outcomes; the latter included operative time, intraoperative blood transfusion, postoperative morbidity and mortality, LOS, rate of vein and R0 resection, number of lymph nodes retrieved, time to adjuvant treatment, DFS, and OS.

Results

Conclusion