AUTHOR=Feng Qingbo , Liao Wenwei , Xin Zechang , Jin Hongyu , Du Jinpeng , Cai Yunshi , Liao Mingheng , Yuan Kefei , Zeng Yong 

TITLE=Laparoscopic Pancreaticoduodenectomy Versus Conventional Open Approach for Patients With Pancreatic Duct Adenocarcinoma: An Up-to-Date Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.749140

DOI=10.3389/fonc.2021.749140

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>To compare perioperative and oncological outcomes of pancreatic duct adenocarcinoma (PDAC) after laparoscopic <italic>versus</italic> open pancreaticoduodenectomy (LPD <italic>vs.</italic> OPD), we performed a meta-analysis of currently available propensity score matching studies and large-scale retrospective cohorts to compare the safety and overall effect of LPD to OPD for patients with PDAC.</p></sec><sec><title>Methods</title><p>A meta-analysis was registered at PROSPERO and the registration number is CRD42021250395. PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Data on operative times, blood loss, 30-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien–Dindo ≥3 complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, overall survival, and long-term survival) were subjected to meta-analysis.</p></sec><sec><title>Results</title><p>Overall, we identified 10 retrospective studies enrolling a total of 11,535 patients (1,514 and 10,021 patients underwent LPD and OPD, respectively). The present meta-analysis showed that there were no significant differences in overall survival time, 1-year survival, 2-year survival, 30-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, and lymph node dissection between the LPD and OPD groups. Nevertheless, compared with the OPD group, LPD resulted in significantly higher rate of R0 resection (OR: 1.22; 95% CI 1.06–1.40; <italic>p</italic> = 0.005), longer operative time (WMD: 60.01 min; 95% CI 23.23–96.79; <italic>p</italic> = 0.001), lower Clavien–Dindo grade ≥III rate (<italic>p</italic> = 0.02), less blood loss (WMD: −96.49 ml; 95% CI −165.14 to −27.83; <italic>p</italic> = 0.006), lower overall morbidity rate (OR: 0.65; 95% CI 0.50 to 0.85; <italic>p</italic> = 0.002), shorter LOS (MD = −2.73; 95% CI −4.44 to −1.03; <italic>p</italic> = 0.002), higher 4-year survival time (<italic>p</italic> = 0.04), 5-year survival time (<italic>p</italic> = 0.001), and earlier time to starting adjuvant chemotherapy after surgery (OR: −10.86; 95% CI −19.42 to −2.30; <italic>p</italic> = 0.01).</p></sec><sec><title>Conclusions</title><p>LPD is a safe and feasible alternative to OPD for patients with PDAC, and compared with OPD, LPD seemed to provide a similar OS.</p></sec><sec><title>Systematic Review Registration</title><p><uri xlink:href="https://www.crd.york.ac.uk/PROSPERO/#recordDetails" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/PROSPERO/#recordDetails</uri>.</p></sec>