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Systematic review and meta-analysis of minimally invasive versus open approach for pancreaticoduodenectomy

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Abstract

Backgrounds and objective

The technique of minimally invasive pancreatic surgeries has evolved rapidly, including minimally invasive pancreaticoduodenectomy (MIPD). However, controversy on safety and feasibility remains when comparing the MIPD with the open pancreaticoduodenectomy (OPD); therefore, we aimed to compare MIPD and OPD with a systemic review and meta-analysis.

Methods

Multiple electronic databases were systematically searched to identify studies (up to February 2016) comparing MIPD with OPD. Intra-operative outcomes, oncologic data, postoperative complications and postoperative recovery were evaluated.

Results

Twenty-two retrospective studies including 6120 patients (1018 MIPDs and 5102 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (WMD −312.00 ml, 95 % CI −436.30 to −187.70 ml, p < 0.001), transfusion rate (OR 0.41, 95 % CI 0.30–0.55, p < 0.001), wound infection (OR 0.37, 95 % CI 0.20–0.66, p < 0.001) and length of hospital stay (WMD −3.57 days, 95 % CI −5.17 to −1.98 days, p < 0.001). Meanwhile, MIPD group has a higher R0 resection rate (OR 1.47, 95 % CI 1.18–1.82, p < 0.001) and more lymph nodes harvest (WMD 1.74, 95 % CI 1.03–2.45, p < 0.001). However, it had longer operation time (WMD 83.91 min, 95 % CI 36.60–131.21 min, p < 0.001). There were no significant differences between the two procedures in morbidities (p = 0.86), postoperative pancreatic fistula (p = 0.17), delayed gastric empting (p = 0.65), vascular resection (p = 0.68), reoperation (p = 0.33) and mortality (p = 0.90).

Conclusions

MIPD can be a reasonable alternative to OPD with potential advantages. However, further large-volume, well-designed RCTs with extensive follow-ups are suggested to confirm and update the findings of our analysis.

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Abbreviations

CI:

Confidence interval

DGE:

Delayed gastric empting

MIPD:

Minimally invasive pancreaticoduodenectomy

OPD:

Open pancreaticoduodenectomy

OR:

Odds ratio

PD:

Pancreaticoduodenectomy

POPF:

Postoperative pancreatic fistula

RCT:

Randomized controlled trial

WMD:

Weighted mean difference

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Author contributions

H. Zhang, M. Wang and R. Y. Qin contributed to study concept and design; H. Zhang and X. H. Wu contributed to literature search, review of the studies and data extractions. F. Zhu and M. Shen contributed to data analysis and data interpretation. C. J. Shi and X. Wang contributed to verify the statistical analysis and scrutinized data. J. X. Jiang, J. Hu and R. Y. Qin provided expert insight. R. Tian and M. Wang contributed to supervision throughout the whole study. All the authors contributed writing the manuscript. All authors approved the final version of the manuscript.

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    Authors and Affiliations

    1. Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China

      Hang Zhang, XiangHu Wu, Feng Zhu, Ming Shen, Rui Tian, ChengJian Shi, Xin Wang, GuangQin Xiao, XingJun Guo, Min Wang & RenYi Qin

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    1. Hang Zhang
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    Correspondence to Min Wang or RenYi Qin.

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    Hang Zhang, XiangHu Wu, Feng Zhu, Ming Shen, Rui Tian, ChengJian Shi, Xin Wang, GuangQin Xiao, XingJun Guo, Min Wang and RenYi Qin declare no conflict of interest.

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    Hang Zhang, XiangHu Wu, and Feng Zhu have contributed equally to this work.

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    Zhang, H., Wu, X., Zhu, F. et al. Systematic review and meta-analysis of minimally invasive versus open approach for pancreaticoduodenectomy. Surg Endosc 30, 5173–5184 (2016). https://doi.org/10.1007/s00464-016-4864-3

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