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Totally laparoscopic or robot-assisted pancreaticoduodenectomy versus open surgery for periampullary neoplasms: separate systematic reviews and meta-analyses

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Abstract

Objective

To compare perioperative and oncologic outcomes of pure (totally) laparoscopic pancreaticoduodenectomy (TLPD) or robot-assisted pancreaticoduodenectomy (RAPD) with those of conventional open pancreaticoduodenectomy (OPD).

Methods

A systematic literature search was performed using PubMed, EMBASE, and Cochrane library databases. Studies comparing TLPD with OPD and RAPD with OPD were included; only original studies reporting more than 10 cases for each technique were included. Studies were combined using a random-effects model to report heterogeneous data, or a fixed-effects model was applied.

Results

TLPD involved longer operative time (weighted mean difference [WMD]: 116.85 min; 95% confidence interval [CI] 54.53–179.17) and significantly shorter postoperative hospital stay (WMD: −3.68 days; 95% CI −4.65 to −2.71). Overall morbidity and postoperative pancreatic fistula were not significantly different between TLPD and OPD. RAPD was associated with a longer operative time, less intraoperative blood loss, and shorter hospital stay. Oncologic outcomes were not significantly different among the procedure types.

Conclusions

Compared to OPD, TLPD and RAPD were feasible and oncologically safe procedures. However, there are no prospective studies, and the majority of the studies on TLPD and RAPD have remained in the early training phase. In addition to randomized controlled trials or prospective studies, new data from the late training phase of learning experiences should also be analyzed.

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Acknowledgement

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Grant Number: HI14C2640). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Sang Hyun Shin, Ki Byung Song, Seong-Ryong Kim, Dae Wook Hwang, Jae Hoon Lee, Kwang-Min Park, Young-Joo Lee & Song Cheol Kim

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Ye-Jee Kim

  3. Department of Biomedical Sciences, University of Ulsan College of Medicine, Seoul, South Korea

    Eunsung Jun

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  1. Sang Hyun Shin
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Correspondence to Song Cheol Kim.

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Disclosures

Sang Hyun Shin, Ye-Jee Kim, Ki Byung Song, Seong-Ryong Kim, Dae Wook Hwang, Jae Hoon Lee, Kwang-Min Park, Young-Joo Lee, Eunsung Jun and Song Cheol Kim have no conflicts of interest or financial ties to disclose.

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Shin, S.H., Kim, YJ., Song, K.B. et al. Totally laparoscopic or robot-assisted pancreaticoduodenectomy versus open surgery for periampullary neoplasms: separate systematic reviews and meta-analyses. Surg Endosc 31, 3459–3474 (2017). https://doi.org/10.1007/s00464-016-5395-7

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