Perioperative, short-term and long-term outcomes of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A Meta-analysis

doi:10.3877/cma.j.issn.1674-0793.2021.04.017

Abstract

Abstract:

Objective

To evaluate the perioperative, short-term and long-term outcomes of minimally invasive pancreatoduodenectomy (MIPD, laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy) for pancreatic ductal adenocarcinoma by meta-analysis.

Methods

Web of science, PubMed, EMBASE, CNKI, VIP, Wanfang data and Chinese biomedical literature databases were searched from the establishment of the database to September 5, 2020. The related research on MIPD and open pancreaticoduodenectomy (OPD) in the treatment of pancreatic ductal adenocarcinoma was collected, and the data were extracted and analyzed by Meta-analysis.

Results

11 909 patients were included in 11 studies, 1 555 patients received MIPD and 10 354 patients received OPD. There were significant differences in the percentage of intraoperative blood transfusion (OR=0.47, 95% CI: 0.33-0.68), length of hospital stay (MD= -3.24, 95% CI: -5.28-1.21), overall postoperative complications (OR=0.66, 95% CI: 0.51-0.86), R0 clearance rate (OR=1.22, 95% CI: 1.06-1.39), the number of lymph nodes removed (MD=1.19, 95% CI: 0.05-2.32, P=0.04), 3-year overall survival rate (OR=1.42, 95% CI: 1.10-1.84), and 5-year overall survival rate (OR=2.11, 95% CI: 1.35-3.31) (P<0.05).

Conclusions

MIPD is safe and feasible in the treatment of pancreatic ductal adenocarcinoma. Compared with OPD, MIPD shows better effect in perioperative related observation indicators, short-term and long-term tumor prognosis.

Key words: Minimally invasive surgery, Pancreatic ductal adenocarcinoma, Pancreaticoduodenectomy, Meta analysis

Xiangyuan Ding, Xiaoying Ren, Huiming Yan. Perioperative, short-term and long-term outcomes of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(04): 313-320.

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References 27

[1]	Ilic M, Ilic I. Epidemiology of pancreatic cancer[J]. World J Gastroenterol, 2016, 22(44): 9694-9705.
[2]	Rahib L, Smith BD, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States[J]. Cancer Res, 2014, 74(11): 2913-2921.
[3]	Hilst JV, Rooij TD, Hilal MA, et al. Worldwide survey on opinions and use of minimally invasive pancreatic resection[J]. HPB (Oxford), 2017, 19(3): 190-204.
[4]	Chopinet S, Fuks D, Rinaudo M, et al. Postoperative bleeding after laparoscopic pancreaticoduodenectomy: the Achilles’ heel?[J]. World J Surg, 2018, 42(4): 1138-1146.
[5]	Chen K, Liu X, Pan Y, et al. Expanding laparoscopic pancreaticoduodenectomy to pancreatic-head and periampullary malignancy: major findings based on systematic review and Meta-analysis[J]. BMC Gastroenterol, 2018, 18(1): 102.
[6]	Chen K, Pan Y, Zhang B, et al. Laparoscopic versus open pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and Meta-analysis[J]. Int J Surg, 2018, 53: 243-256.
[7]	Chapman BC, Gajdos C, Hosokawa P, et al. Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma[J]. Surg Endosc, 2018, 32(5): 2239-2248.
[8]	Chen S, Chen JZ, Zhan Q, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: A prospective, matched, mid-term follow-up study[J]. Surg Endosc, 2015, 29(12): 3698-3711.
[9]	Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?[J]. Ann Surg, 2014, 260(4): 633-638.
[10]	Delitto D, Luckhurst CM, Black BS, et al. Oncologic and perioperative outcomes following selective application of laparoscopic pancreaticoduodenectomy for periampullary malignancies[J]. J Gastrointest Surg, 2016, 20(7): 1343-1349.
[11]	Dokmak S, Ftériche FS, Aussilhou B, et al. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors[J]. J Am Coll Surg, 2015, 220(5): 831-838.
[12]	Kantor O, Talamonti MS, Sharpe S, et al. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy[J]. Am J Surg, 2017, 213(3): 512-515.
[13]	Kuesters S, Chikhladze S, Makowiec F, et al. Oncological outcome of laparoscopically assisted pancreatoduodenectomy for ductal adenocarcinoma in a retrospective cohort study[J]. Int J Surg, 2018, 55: 162-166.
[14]	Kwon J, Song KB, Park SY, et al. Comparison of minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: A propensity score matching analysis[J]. Cancers, 2020, 12(4): 982.
[15]	Song KB, Kim SC, Hwang DW, et al. Matched case-control analysis comparing laparoscopic and open pylorus-preserving pancreaticoduodenectomy in patients with periampullary tumors[J]. Ann Surg, 2015, 262(1): 146-155.
[16]	Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution[J]. Surg Endosc, 2017, 31(5): 2233-2241.
[17]	Weng Y, Jiang Y, Fu N, et al. Oncological outcomes of robotic-assisted versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: A propensity score-matched analysis[J]. Surg Endosc, 2020, 35(7): 3437-3448.
[18]	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy[J]. Surg Endosc, 1994, 8(5): 408-410.
[19]	Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital[J]. Arch Surg, 2003, 138(7): 777-784.
[20]	Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: A single institution’s experience in open, laparoscopic, and robotic approaches[J]. J Am Coll Surg, 2015, 220(1): 18-27.
[21]	Soh YF, Kow AW, Wong KY, et al. Perioperative outcomes of laparoscopic and open distal pancreatectomy: our institution’s 5-year experience[J]. Asian J Surg, 2012, 35(1): 29-36.
[22]	Eom BW, Jang JY, Lee SE, et al. Clinical outcomes compared between laparoscopic and open distal pancreatectomy[J]. Surg Endosc, 2008, 22(5): 1334-1338.
[23]	Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: A retrospective multicenter analysis of 1 029 patients[J]. Ann Surg, 2021, 273(1): 145-153.
[24]	Kneuertz PJ, Patel SH, Chu CK, et al. Effects of perioperative red blood cell transfusion on disease recurrence and survival after pancreaticoduodenectomy for ductal adenocarcinoma[J]. Ann Surg Oncol, 2011, 18(5): 1327-1334.
[25]	Wu WC, Smith TS, Henderson WG, et al. Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery[J]. Ann Surg, 2010, 252(1): 11-17.
[26]	Mirkin KA, Greenleaf EK, Hollenbeak CS, et al. Minimally invasive surgical approaches offer earlier time to adjuvant chemotherapy but not improved survival in resected pancreatic cancer[J]. Surg Endosc, 2018, 32(5): 2387-2396.
[27]	Zhang H, Wu XH, Zhu F, et al. Systematic review and meta-analysis of minimally invasive versus open approach for pancreaticoduodenectomy[J]. Surg Endosc, 2016, 30(12): 5173-5184.

基础信息	文献篇数	异质性		效应模型	Meta分析
基础信息	文献篇数	I²(%)	P值	效应模型	OR/MD (95% CI)	P值
年龄	6	55	0.06	随机效应模型	0.57 (-0.28,1.43)	0.19
性别	5	0	0.42	固定效应模型	1.22 (0.97,1.54)	0.10
体质指数	4	0	0.99	固定效应模型	0.12 (-0.37,0.61)	0.64
肿瘤大小	7	97	<0.001	随机效应模型	-0.12 (-0.55,0.31)	0.58

基础信息	文献篇数	异质性		效应模型	Meta分析
基础信息	文献篇数	I²(%)	P值	效应模型	OR/MD (95% CI)	P值
年龄	6	55	0.06	随机效应模型	0.57 (-0.28,1.43)	0.19
性别	5	0	0.42	固定效应模型	1.22 (0.97,1.54)	0.10
体质指数	4	0	0.99	固定效应模型	0.12 (-0.37,0.61)	0.64
肿瘤大小	7	97	<0.001	随机效应模型	-0.12 (-0.55,0.31)	0.58

第一作者及发表年	国家	研究类型	样本量(例)		中转开腹率[例(%)]	随访时间(月)		NOS评分
第一作者及发表年	国家	研究类型	MIPD	OPD	中转开腹率[例(%)]	MIPD	OPD	NOS评分
Chapman 2018^[7]	美国	回顾性研究	248	1520	74(29.8)	17.1	14	8
Chen 2015^[8]	中国	回顾性研究	19	38	1(5.3)	22±10	21±8	7
Croome 2014^[9]	美国	回顾性研究	108	214	7(6.5)	16.5	15.1	8
Delitto 2016^[10]	美国	回顾性研究	28	22	-	-	-	7
Dokmak 2015^[11]	法国	回顾性研究	11	261	-	-	-	6
Kantor 2017^[12]	美国	回顾性研究	828	7385	-	18	-	8
Kuesters 2018^[13]	德国	回顾性研究	62	278	-	-	-	7
Kwon 2020^[14]	韩国	回顾性研究	73	219	-	-	-	7
Song 2015^[15]	韩国	回顾性研究	15	14	-	-	-	6
Staufer 2017^[16]	美国	回顾性研究	58	193	14(24.1)	19.6±17.4	24.5±27.4	8
Weng 2020^[17]	中国	回顾性研究	105	210	2(1.8)	-	-	7

第一作者及发表年	国家	研究类型	样本量(例)		中转开腹率[例(%)]	随访时间(月)		NOS评分
第一作者及发表年	国家	研究类型	MIPD	OPD	中转开腹率[例(%)]	MIPD	OPD	NOS评分
Chapman 2018^[7]	美国	回顾性研究	248	1520	74(29.8)	17.1	14	8
Chen 2015^[8]	中国	回顾性研究	19	38	1(5.3)	22±10	21±8	7
Croome 2014^[9]	美国	回顾性研究	108	214	7(6.5)	16.5	15.1	8
Delitto 2016^[10]	美国	回顾性研究	28	22	-	-	-	7
Dokmak 2015^[11]	法国	回顾性研究	11	261	-	-	-	6
Kantor 2017^[12]	美国	回顾性研究	828	7385	-	18	-	8
Kuesters 2018^[13]	德国	回顾性研究	62	278	-	-	-	7
Kwon 2020^[14]	韩国	回顾性研究	73	219	-	-	-	7
Song 2015^[15]	韩国	回顾性研究	15	14	-	-	-	6
Staufer 2017^[16]	美国	回顾性研究	58	193	14(24.1)	19.6±17.4	24.5±27.4	8
Weng 2020^[17]	中国	回顾性研究	105	210	2(1.8)	-	-	7

指标	文献篇数	样本量(例)		异质性		效应模型	Meta分析
指标	文献篇数	MIPD	OPD	I²(%)	P值	效应模型	OR/MD(95% CI)	P值
手术时间	4	33	895	98	<0.001	随机效应模型	40.17 (-17.75, 99.28)	0.170
术中失血量	4	317	663	91	<0.001	随机效应模型	-110.79 (-266.20, 44.61)	0.160
住院时间	7	1 424	9 814	80	<0.001	随机效应模型	-3.24 (-5.28, -1.21)	0.002
术后总体并发症	5	316	918	23	0.26	固定效应模型	0.66 (0.51, 0.86)	0.002
30 d死亡率	7	1 377	9 882	0	0.65	固定效应模型	1.00 (0.71,1.42)	0.980
术中输血	3	228	685	0	0.80	固定效应模型	0.47 (0.33, 0.68)	<0.001
术后胰瘘	5	359	850	0	0.99	固定效应模型	0.87 (0.54, 1.39)	0.550
延迟胃排空	5	359	850	65	0.02	随机效应模型	1.36 (0.51, 3.66)	0.540
术后出血	5	359	850	0	0.57	固定效应模型	1.27 (0.69, 2.35)	0.440

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