Abstract
Objective
Assessment of minimally invasive pancreatoduodenectomy (MIPD) in patients with pancreatic
ductal adenocarcinoma (PDAC) is scarce and limited to non-randomized studies. This
study aimed to compare oncological and surgical outcomes after MIPD compared to open
pancreatoduodenectomy (OPD) for patients after resectable PDAC from published randomized
controlled trials (RCTs).
Methods
A systematic review was performed to identify RCTs comparing MIPD and OPD including
PDAC (Jan 2015–July 2021). Individual data of patients with PDAC were requested. Primary
outcomes were R0 rate and lymph node yield. Secondary outcomes were blood-loss, operation
time, major complications, hospital stay and 90-day mortality.
Results
Overall, 4 RCTs (all addressed laparoscopic MIPD) with 275 patients with PDAC were
included. In total, 128 patients underwent laparoscopic MIPD and 147 patients underwent
OPD. The R0 rate (risk difference(RD) −1%, P = 0.740) and lymph node yield (mean difference(MD) +1.55, P = 0.305) were comparable between laparoscopic MIPD and OPD. Laparoscopic MIPD was
associated with less perioperative blood-loss (MD -91ml, P = 0.026), shorter length of hospital stay (MD -3.8 days, P = 0.044), while operation time was longer (MD +98.5 min, P = 0.003). Major complications (RD -11%, P = 0.302) and 90-day mortality (RD -2%, P = 0.328) were comparable between laparoscopic MIPD and OPD.
Conclusions
This individual patient data meta-analysis of MIPD versus OPD in patients with resectable
PDAC suggests that laparoscopic MIPD is non-inferior regarding radicality, lymph node
yield, major complications and 90-day mortality and is associated with less blood
loss, shorter hospital stay, and longer operation time. The impact on long-term survival
and recurrence should be studied in RCTs including robotic MIPD.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Optimizing the outcomes of pancreatic cancer surgery.Nat Rev Clin Oncol. 2019; 16: 11-26https://doi.org/10.1038/s41571-018-0112-1
- Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible?.Ann Surg. 2008; 247: 456-462https://doi.org/10.1097/SLA.0b013e3181613142
- Analysis of long-term survivors after surgical resection for pancreatic cancer.Pancreas. 2006; 32: 271-275https://doi.org/10.1097/01.mpa.0000202953.87740.93
- Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial.J Clin Oncol. 2020; 38: 1763-1773https://doi.org/10.1200/JCO.19.02274
- Neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer: long-term results of the Dutch randomized PREOPANC trial.J Clin Oncol. 2022; 40: 1220-1230https://doi.org/10.1200/JCO.21.02233
- Systematic review on the impact of pancreatoduodenectomy on quality of life in patients with pancreatic cancer.HPB. 2018; 20: 204-215https://doi.org/10.1016/j.hpb.2017.11.002
- Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections.Surg Endosc. 2022; https://doi.org/10.1007/s00464-022-09735-4
- 500 minimally invasive robotic pancreatoduodenectomies.Ann Surg. 2021; 273: 966-972https://doi.org/10.1097/SLA.0000000000003550
- Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: contemporary experience of a “self-taught” early adopter in Southeast Asia.J Minimal Access Surg. 2020; 16: 341-347https://doi.org/10.4103/jmas.JMAS_94_19
- Worldwide survey on opinions and use of minimally invasive pancreatic resection.HPB. 2017; 19: 190-204https://doi.org/10.1016/j.hpb.2017.01.011
- Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial.Lancet Gastroenterol Hepatol. 2019; 4: 199-207https://doi.org/10.1016/s2468-1253(19)30004-4
- Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours.Br J Surg. 2017; 104: 1443-1450https://doi.org/10.1002/bjs.10662
- Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial.Ann Surg. 2018; 268: 731-739https://doi.org/10.1097/SLA.0000000000002893
- Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial.Lancet Gastroenterol Hepatol. 2021; 6: 438-447https://doi.org/10.1016/S2468-1253(21)00054-6
- Histopathologic predictors of survival and recurrence in resected ampullary adenocarcinoma: international multicenter cohort study.Ann Surg. 2020; 272: 1086-1093https://doi.org/10.1097/SLA.0000000000003177
- Predictors of survival in periampullary cancers following pancreaticoduodenectomy.Ann Surg Oncol. 2010; 17: 991-997https://doi.org/10.1245/s10434-009-0883-9
- Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up.Surgery. 2006; 140: 764-772https://doi.org/10.1016/j.surg.2006.04.006
- Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?.Ann Surg. 2014; 260 (discussion 638-40): 633-638https://doi.org/10.1097/SLA.0000000000000937
- Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy.Am J Surg. 2017; 213: 512-515https://doi.org/10.1016/j.amjsurg.2016.10.030
- Comparison of minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis.Cancers. 2020; 12https://doi.org/10.3390/cancers12040982
- Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution.Surg Endosc. 2017; 31: 2233-2241https://doi.org/10.1007/s00464-016-5222-1
- Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis.Cancer Commun. 2019; 39: 66https://doi.org/10.1186/s40880-019-0410-8
- Systematic review and meta-analysis of minimally invasive versus open approach for pancreaticoduodenectomy.Surg Endosc. 2016; 30: 5173-5184https://doi.org/10.1007/s00464-016-4864-3
- A systemic review and an updated meta-analysis: minimally invasive vs open pancreaticoduodenectomy.Sci Rep. 2017; 7: 2220https://doi.org/10.1038/s41598-017-02488-4
- TJ Cochrane Handbook for systematic reviews of Interventions version 6.3 (updated february 2022). 2022 (Cochrane)
- Preferred reporting Items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement.JAMA. 2015; 313: 1657-1665https://doi.org/10.1001/jama.2015.3656
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ Br Med J (Clin Res Ed). 2019; 366 (ARTN l4898 10.1136/bmj.l4898)
- Origin of the ASA classification.Anesthesiology. 1979; 51: 179https://doi.org/10.1097/00000542-197908000-00023
- Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery.Surgery. 2017; 161: 365-372https://doi.org/10.1016/j.surg.2016.06.058
- Modifications in the international study group for pancreatic surgery (ISGPS) definition of postoperative pancreatic fistula.Transl Gastroenterol Hepatol. 2017; 2: 107https://doi.org/10.21037/tgh.2017.11.14
- Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition.Surgery. 2007; 142: 20-25https://doi.org/10.1016/j.surg.2007.02.001
- Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).Surgery. 2007; 142: 761-768https://doi.org/10.1016/j.surg.2007.05.005
- Update on surgical site infections: the new CDC guidelines.J Am Acad Physician Assistants. 2018; 31: 52-54https://doi.org/10.1097/01.JAA.0000531052.82007.42
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196https://doi.org/10.1097/SLA.0b013e3181b13ca2
- The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.Ann Surg Oncol. 2010; 17: 1471-1474https://doi.org/10.1245/s10434-010-0985-4
- Dataset for histopathological reporting of carcinomas of the pancreas, ampulla of Vater and common bile duct.The Royal College of Pathologists, 2019
- Odds of transfusion for older adults compared to younger adults undergoing surgery.Anesth Analg. 2014; 118: 1168-1178https://doi.org/10.1213/ANE.0000000000000033
- Reduction in delayed gastric emptying following non-pylorus preserving pancreaticoduodenectomy by addition of a Braun enteroenterostomy.JOP. 2012; 13: 488-496https://doi.org/10.6092/1590-8577/800
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928https://doi.org/10.1136/bmj.d5928
- Bias in location and selection of studies.BMJ. 1998; 316: 61-66https://doi.org/10.1136/bmj.316.7124.61
- Misleading funnel plot for detection of bias in meta-analysis.J Clin Epidemiol. 2000; 53: 477-484https://doi.org/10.1016/s0895-4356(99)00204-8
- Systematic review and updated network meta-analysis comparing open, laparoscopic, and robotic pancreaticoduodenectomy.Updates Surg. 2021; 73: 909-922https://doi.org/10.1007/s13304-020-00916-1
- Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials.HPB, Oxford2022https://doi.org/10.1016/j.hpb.2022.02.005
- Laparoscopic pancreaticoduodenectomy versus conventional open approach for patients with pancreatic duct adenocarcinoma: an up-to-date systematic review and meta-analysis.Front Oncol. 2021; 11749140https://doi.org/10.3389/fonc.2021.749140
- Comparison of overall survival and perioperative outcomes of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis.BMC Cancer. 2019; 19: 781https://doi.org/10.1186/s12885-019-6001-x
- Minimally invasive pancreaticoduodenectomy in elderly patients: systematic review and meta-analysis.World J Surg. 2021; 45: 1186-1201https://doi.org/10.1007/s00268-020-05945-w
- Redefining the R1 resection in patients with pancreatic ductal adenocarcinoma.J Hepatobiliary Pancreat Sci. 2016; 23: 523-532https://doi.org/10.1002/jhbp.374
- Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS).Surgery. 2014; 156: 591-600https://doi.org/10.1016/j.surg.2014.06.016
- Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience.Surg Endosc. 2010; 24: 1646-1657https://doi.org/10.1007/s00464-009-0825-4
- Perioperative and oncological outcomes following minimally invasive versus open pancreaticoduodenectomy for pancreatic duct adenocarcinoma.Surg Endosc. 2021; 35: 2273-2285https://doi.org/10.1007/s00464-020-07641-1
- Outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LAELAPS-2).Ann Surg. 2019; 269: 344-350https://doi.org/10.1097/SLA.0000000000002563
- Robotic versus conventional laparoscopic pancreaticoduodenectomy a systematic review and meta-analysis.Eur J Surg Oncol. 2020; 46: 6-14https://doi.org/10.1016/j.ejso.2019.08.007
- Minimally invasive pancreatoduodenectomy: is the incidence of clinically relevant postoperative pancreatic fistula comparable to that after open pancreatoduodenectomy?.Surgery. 2018; 163: 587-593https://doi.org/10.1016/j.surg.2017.12.001
- Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors.J Am Coll Surg. 2015; 220: 831-838https://doi.org/10.1016/j.jamcollsurg.2014.12.052
- Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials.Ann Surg. 2020; 271: 54-66https://doi.org/10.1097/SLA.0000000000003309
- Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy.BMC Cancer. 2021; 21: 382https://doi.org/10.1186/s12885-021-08117-8
- Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: a review of the literature and critical reappraisal of the implicated pathomechanism.World J Gastroenterol. 2006; 12: 5951-5958https://doi.org/10.3748/wjg.v12.i37.5951
- Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy.Br J Surg. 2018; 105: 339-349https://doi.org/10.1002/bjs.10771
- Neoadjuvant and adjuvant chemotherapy in pancreatic cancer.Langenbeck's Arch Surg. 2018; 403: 917-932https://doi.org/10.1007/s00423-018-1724-8
Article info
Publication history
Published online: April 06, 2023
Accepted:
March 24,
2023
Received in revised form:
January 31,
2023
Received:
November 14,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
