Expanding Laparoscopic Pancreaticoduodenectomy to Pancreatic-head and Periampullary Malignancy: Major Findings Based on Systematic Review and Meta-analysis

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2018 Jul 5

PMID 29969999

Citations 22

Authors

Ke Chen

Xiao-Long Liu

Yu Pan

Hendi Maher

Xian-Fa Wang

Affiliations

Soon will be listed here.

Abstract

Background: Laparoscopic pancreaticoduodenectomy (LPD) remains to be established as a safe and effective alternative to open pancreaticoduodenectomy (OPD) for pancreatic-head and periampullary malignancy. The purpose of this meta-analysis was to compare LPD with OPD for these malignancies regarding short-term surgical and long-term survival outcomes.

Methods: A literature search was conducted before March 2018 to identify comparative studies in regard to outcomes of both LPD and OPD for the treatment of pancreatic-head and periampullary malignancies. Morbidity, postoperative pancreatic fistula (POPF), mortality, operative time, estimated blood loss, hospitalization, retrieved lymph nodes, and survival outcomes were compared.

Results: Among eleven identified studies, 1196 underwent LPD, and 8247 were operated through OPD. The pooled data showed that LPD was associated with less morbidity (OR = 0.57, 95%CI: 0.41~ 0.78, P < 0.01), less blood loss (WMD = - 372.96 ml, 95% CI, - 507.83~ - 238.09 ml, P < 0.01), shorter hospital stays (WMD = - 197.49 ml, 95% CI, - 304.62~ - 90.37 ml, P < 0.01), and comparable POPF (OR = 0.85, 95%CI: 0.59~ 1.24, P = 0.40), and overall survival (HR = 1.03, 95%CI: 0.93~ 1.14, P = 0.54) compared to OPD. Operative time was longer in LPD (WMD = 87.68 min; 95%CI: 27.05~ 148.32, P < 0.01), whereas R0 rate tended to be higher in LPD (OR = 1.17; 95%CI: 1.00~ 1.37, P = 0.05) and there tended to be more retrieved lymph nodes in LPD (WMD = 1.15, 95%CI: -0.16~ 2.47, P = 0.08), but these differences failed to reach statistical significance.

Conclusions: LPD can be performed as safe and effective as OPD for pancreatic-head and periampullary malignancy with respect to both surgical and oncological outcomes. LPD is associated with less intraoperative blood loss and postoperative morbidity and may serve as a promising alternative to OPD in selected individuals in the future.

Citing Articles

Impact of overweight on patients undergoing laparoscopic pancreaticoduodenectomy: analysis of surgical outcomes in a high-volume center.

Li D, Wang S, Zhang H, Cao Y, Chu Q BMC Surg. 2024; 24(1):372.

PMID: 39578746 PMC: 11583451. DOI: 10.1186/s12893-024-02671-1.

Risk factors of textbook outcome in laparoscopic pancreatoduodenectomy: results from a prospective high-volume center study.

Cai H, Lu F, Gao P, Zhang M, Wang X, Li Y BMC Surg. 2024; 24(1):233.

PMID: 39152385 PMC: 11328470. DOI: 10.1186/s12893-024-02529-6.

Sociodemographic variation in the utilization of minimally invasive surgical approaches for pancreatic cancer.

Tran A, Zheng R, Johnston F, He J, Burns W, Shubert C HPB (Oxford). 2024; 26(10):1280-1290.

PMID: 39033045 PMC: 11446651. DOI: 10.1016/j.hpb.2024.07.403.

Laparoscopic Versus Open Pancreatoduodenectomy for Periampullary Tumors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Reis P, Bittar V, Almiron G, Schramm A, Oliveira J, Cagnacci R J Gastrointest Cancer. 2024; 55(3):1058-1068.

PMID: 39028397 DOI: 10.1007/s12029-024-01091-x.

Effect of Laparoscopic and Open Pancreaticoduodenectomy for Pancreatic or Periampullary Tumors: Three-year Follow-up of a Randomized Clinical Trial.

Qin T, Zhang H, Pan S, Liu J, Li D, Chen R Ann Surg. 2023; 279(4):605-612.

PMID: 37965767 PMC: 10922659. DOI: 10.1097/SLA.0000000000006149.

References

Riviere D, Gurusamy K, Kooby D, Vollmer C, Besselink M, Davidson B . Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev. 2016; 4:CD011391. PMC: 7083263. DOI: 10.1002/14651858.CD011391.pub2. View

Wittekind C, Compton C, Quirke P, Nagtegaal I, Merkel S, Hermanek P . A uniform residual tumor (R) classification: integration of the R classification and the circumferential margin status. Cancer. 2009; 115(15):3483-8. DOI: 10.1002/cncr.24320. View

Croome K, Farnell M, Que F, Reid-Lombardo K, Truty M, Nagorney D . Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?. Ann Surg. 2014; 260(4):633-8. DOI: 10.1097/SLA.0000000000000937. View

Distler M, Ruckert F, Hunger M, Kersting S, Pilarsky C, Saeger H . Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinoma. BMC Surg. 2013; 13:12. PMC: 3639824. DOI: 10.1186/1471-2482-13-12. View

Tierney J, Stewart L, Ghersi D, Burdett S, Sydes M . Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007; 8:16. PMC: 1920534. DOI: 10.1186/1745-6215-8-16. View

Kim K, Chie E, Jang J, Kim S, Oh D, Im S . Role of adjuvant chemoradiotherapy for ampulla of Vater cancer. Int J Radiat Oncol Biol Phys. 2009; 75(2):436-41. DOI: 10.1016/j.ijrobp.2008.11.067. View

Peng L, Lin S, Li Y, Xiao W . Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy. Surg Endosc. 2016; 31(8):3085-3097. DOI: 10.1007/s00464-016-5371-2. View

Hakeem A, Verbeke C, Cairns A, Aldouri A, Smith A, Menon K . A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol. Hepatobiliary Pancreat Dis Int. 2014; 13(4):435-41. DOI: 10.1016/s1499-3872(14)60048-5. View

Nussbaum D, Adam M, Youngwirth L, Ganapathi A, Roman S, Tyler D . Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma. Ann Surg Oncol. 2015; 23(3):1026-33. DOI: 10.1245/s10434-015-4937-x. View

10.

Demir I, Jager C, Schlitter A, Konukiewitz B, Stecher L, Schorn S . R0 Versus R1 Resection Matters after Pancreaticoduodenectomy, and Less after Distal or Total Pancreatectomy for Pancreatic Cancer. Ann Surg. 2017; 268(6):1058-1068. DOI: 10.1097/SLA.0000000000002345. View

11.

Luo J, Xiao L, Wu C, Zheng Y, Zhao N . The incidence and survival rate of population-based pancreatic cancer patients: Shanghai Cancer Registry 2004-2009. PLoS One. 2013; 8(10):e76052. PMC: 3794034. DOI: 10.1371/journal.pone.0076052. View

12.

Howard T, Krug J, Yu J, Zyromski N, Schmidt C, Jacobson L . A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon's contribution to long-term survival in pancreatic cancer. J Gastrointest Surg. 2006; 10(10):1338-45. DOI: 10.1016/j.gassur.2006.09.008. View

13.

Ecker B, McMillan M, Asbun H, Ball C, Bassi C, Beane J . Characterization and Optimal Management of High-risk Pancreatic Anastomoses During Pancreatoduodenectomy. Ann Surg. 2017; 267(4):608-616. DOI: 10.1097/SLA.0000000000002327. View

14.

Qin H, Qiu J, Zhao Y, Pan G, Zeng Y . Does minimally-invasive pancreaticoduodenectomy have advantages over its open method? A meta-analysis of retrospective studies. PLoS One. 2014; 9(8):e104274. PMC: 4132100. DOI: 10.1371/journal.pone.0104274. View

15.

Shin S, Kim Y, Song K, Kim S, Hwang D, Lee J . Totally laparoscopic or robot-assisted pancreaticoduodenectomy versus open surgery for periampullary neoplasms: separate systematic reviews and meta-analyses. Surg Endosc. 2017; 31(9):3459-3474. DOI: 10.1007/s00464-016-5395-7. View

16.

Ramana C, DeBerge M, Kumar A, Alia C, Durbin J, Enelow R . Inflammatory impact of IFN-γ in CD8+ T cell-mediated lung injury is mediated by both Stat1-dependent and -independent pathways. Am J Physiol Lung Cell Mol Physiol. 2015; 308(7):L650-7. PMC: 4385989. DOI: 10.1152/ajplung.00360.2014. View

17.

Correa-Gallego C, Dinkelspiel H, Sulimanoff I, Fisher S, Vinuela E, Kingham T . Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg. 2013; 218(1):129-39. DOI: 10.1016/j.jamcollsurg.2013.09.005. View

18.

Rahib L, Smith B, Aizenberg R, Rosenzweig A, Fleshman J, Matrisian L . Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014; 74(11):2913-21. DOI: 10.1158/0008-5472.CAN-14-0155. View

19.

Stauffer J, Coppola A, Villacreses D, Mody K, Johnson E, Li Z . Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc. 2016; 31(5):2233-2241. DOI: 10.1007/s00464-016-5222-1. View

20.

Lei P, Wei B, Guo W, Wei H . Minimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety. Surg Laparosc Endosc Percutan Tech. 2014; 24(4):296-305. DOI: 10.1097/SLE.0000000000000054. View