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Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic outcomes and long-term survival

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Abstract

Objective

The study aimed to compare the oncologic outcomes and long-term survival of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for patients diagnosed with pancreatic ductal adenocarcinoma (PDAC).

Background

Substantial evidence demonstrated that LPD is technically safe and feasible with perioperative outcomes equivalent to that of OPD. However, for patients with malignancy, especially PDAC, the oncologic outcomes and long-term survival of patients who underwent LPD remains to be elucidated.

Methods

Studies on LPD for the treatment of PDAC published before December 25, 2018 were searched online. The oncologic outcomes (e.g., numbers of lymph nodes retrieved, negative margin (R0) resection), and long-term survival (postoperative survival from 1 to 5 year) of LPD were compared to that of ODP.

Results

After screening 1507 studies, six comparative cohort studies, which reported the oncologic outcomes and long-term survival of patients with PDAC were included. No significant difference was found between LPD and OPD regarding lymph nodes harvested (OR 1.96, 95% CI − 1.17 to 5.09, p = 0.22), R0 rate (OR 1.44, 95% CI 1.00 to 2.06, p = 0.05), number of positive lymph nodes (OR − 0.44, 95% CI − 1.06 to 0.17, p = 0.16), rate of adjuvant treatment (OR 1.04, 95% CI 0.68 to 1.59, p = 0.86) and time to adjuvant treatment (OR − 6.21, 95% CI − 16.00 to 3.59, p = 0.21). LPD showed similar 1-year (OR 1.20, 95% CI 0.87 to 1.65, p = 0.28), and 2-year survival (OR 1.25, 95% CI 0.94 to 1.66, p = 0.13) to that of OPD. The 3-year (OR 1.50, 95% CI 1.12 to 2.02, p = 0.007), 4-year (OR 1.73, 95% CI 1.02 to 2.93, p = 0.04), and 5-year survival (OR 2.11, 95% CI 1.35 to 3.31, p = 0.001) were significantly longer in LPD group.

Conclusion

For the treatment of PDAC, the oncologic outcomes of LPD were equivalent to that of OPD; LPD seemed promising regarding the postoperative long-term survival.

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Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China (Grant No. 81802623), Zhejiang Province Key Science and Technology (Grant No. 2015C03049), Zhejiang Province Medical and Health Platform support (Grant No. 2015DTA010).

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Author notes

  1. Ke Chen and Yucheng Zhou authors contribute equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology & Pancreatic Surgery, Zhejiang Province People’s Hospital, No 158 Shangtang Road, Hangzhou, 310000, Zhejiang, People’s Republic of China

    Ke Chen, Yucheng Zhou, Weiwei Jin, Qicong Zhu, Chao Lu, Nan Niu, Yuanyu Wang & Yiping Mou

  2. Department of Medical Oncology, Zhejiang Province People’s Hospital, No.158 Shangtang Road, Hangzhou, 310000, Zhejiang, People’s Republic of China

    Zheling Chen

  3. Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, 310014, Zhejiang, People’s Republic of China

    Ke Chen, Yucheng Zhou, Yiping Mou & Zheling Chen

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  1. Ke Chen
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Correspondence to Yiping Mou or Zheling Chen.

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Disclosures

Drs. Ke Chen, Yucheng Zhou, Weiwei Jin, Qicong Zhu, Chao Lu, Nan Niu, Yuanyu Wang, Yiping Mou, and Zheling Chen have no conflicts of interest or financial ties to disclose.

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Chen, K., Zhou, Y., Jin, W. et al. Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic outcomes and long-term survival. Surg Endosc 34, 1948–1958 (2020). https://doi.org/10.1007/s00464-019-06968-8

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