Total laparoscopic pancreaticoduodenectomy <i>versus</i> open pancreaticoduodenectomy: a meta-analysis based on non-RCT studies_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Kangyi , GAO Fengwei ,  LEI Zehua , FU Jinqiang , DU Bo , WANG Zhixu , XIE Qingyun , ZHOU Quanyu , XUE Qian , ZHAO Xin

Department of Hepatobiliary Pancreatic and Splenic Surgery, The People's Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

LEI Zehua, Email: leitsehua@126.com

Keywords：

pancreaticoduodenectomy; laparoscopic operation; open operation; meta-analysis

DOI：

10.7507/1007-9424.201812067

Video：

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Objective This meta-analysis aimed to systematically evaluate the feasibility and the safety of total laparoscopic pancreatoduodenectomy (TLPD) by comparing it with open pancreatoduodenectomy (OPD).Methods We searched the relative domestic and international data bases systematically, such as the Cochrane Library, Medline Database, SCI, CBM, VIP-data, CNKI-data, and WanFang Data. We selected case control studies or cohort studies, and used the Review Manager 5.3 to perform statistical analysis.Results In total, thirteen single-center retrospective case-control studies were included, totally 808 patients involved, and there were 401 cases in the TLPD group and 407 cases in the OPD group. There were no significant difference in terms of the cumulative morbidity, incidence of the Clavien Ⅲ-Ⅴ complication, pancreatic fistula, B/C pancreatic fistula, biliary fistula, postoperative hemorrhage, pulmonary infection, and gastric emptying delay, as well as the ratio of secondary operation, mortality of perioperative period, the ration of R0 resection, and the number of lymph nodes dissected between the 2 groups (P>0.05). Although the operative time was significant longer, TLPD had significant superiority in terms of the amount of bleeding and blood transfusion during operation, the hospital stays after operation, the bowel function recovery time, the time to restart eating, and the time to reactivate (P<0.05).Conclusion In terms of the relative complications and the parameters of oncology such as the ration of R0 resection, the number of lymph nodes dissected, both of the procedures are safe and feasible, while TLPD is more favorable to control operative bleeding and accelerate rehabilitation.

Citation： JIANG Kangyi, GAO Fengwei, LEI Zehua, FU Jinqiang, DU Bo, WANG Zhixu, XIE Qingyun, ZHOU Quanyu, XUE Qian, ZHAO Xin. Total laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy: a meta-analysis based on non-RCT studies. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(4): 448-457. doi: 10.7507/1007-9424.201812067 Copy

1.	彭兵, 王明俊. 腹腔镜胰十二指肠切除术的历史与现状. 中国普外基础与临床杂志, 2016, 23(4): 385-387.
2.	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
3.	洪德飞. 腹腔镜胰腺切除术发展机遇与挑战. 浙江医学, 2017, 39(22): 1943-1947.
4.	Sally G, Julian PH, Philip A, et al. Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration, 2008.
5.	Zureikat AH, Breaux JA, Steel JL, et al. Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg, 2011, 15(7): 1151-1157.
6.	卫洪波, 魏波, 郑宗珩, 等. 腹腔镜与开放胰十二指肠切除术疗效的对比观察. 中华胃肠外科杂志, 2014, 17(5): 465-468.
7.	Hakeem AR, Verbeke CS, Cairns A, et al. A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol. Hepatobiliary Pancreat Dis Int, 2014, 13(4): 435-441.
8.	Tan CL, Zhang H, Peng B, et al. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol, 2015, 21(17): 5311-5319.
9.	魏秋亚, 刘永永, 闫卫峰, 等. 全腹腔镜与开腹胰十二指肠切除术的临床配对研究. 中华肝胆外科杂志, 2016, 22(5): 332-335.
10.	Khaled YS, Fatania K, Barrie J, et al. Matched case-control comparative study of laparoscopic versus open pancreaticoduodenectomy for malignant lesions. Surg Laparosc Endosc Percutan Tech, 2018, 28(1): 47-51.
11.	Conrad C, Basso V, Passot G, et al. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. Surg Endosc, 2017, 31(10): 3970-3978.
12.	王文斌, 闫长青, 吕海涛, 等. 腹腔镜与开腹胰十二指肠切除术疗效分析. 中华肝胆外科杂志, 2017, 23(2): 110-113.
13.	吴万龙, 王明俊, 蔡云强, 等. 腹腔镜与开腹胰十二指肠切除术近期疗效的对比研究. 外科理论与实践, 2017, 22(2): 123-128.
14.	符真, 张剑权, 陈汉宗. 腹腔镜与开放手术方式在胰十二指肠切除术中的应用比较. 广东医学, 2017, 38(15): 2367-2370.
15.	李方宽, 王小明, 孙卫东, 等. 腹腔镜和开腹胰十二指肠切除术的近期临床疗效对比. 皖南医学院学报, 2017, 36(6): 535-538.
16.	王哲元, 张亚武, 权柯. 腹腔镜与传统手术治疗胆总管下段癌的临床疗效对比. 医学研究杂志, 2017, 46(12): 143-148.
17.	Chen XM, Sun DL, Zhang Y. Laparoscopic versus open pancreaticoduodenectomy combined with uncinated process approach: a comparative study evaluating perioperative outcomes (retrospective cohort study). Int J Surg, 2018, 51: 170-173.
18.	Cai Y, Gao P, Li Y, et al. Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc, 2018, 32(10): 4209-4215.
19.	金巍巍, 徐晓武, 牟一平, 等. 腹腔镜胰十二指肠切除术单中心 233 例临床经验总结. 中华外科杂志, 2017, 55(5): 354-358.
20.	刘学青, 邢中强, 秦建章, 等. 腹腔镜胰十二指肠切除术单中心 300 例临床分析. 中国实用外科杂志, 2018, 38(3): 306-311.
21.	姜翀弋, 王巍. 腹腔镜胰十二指肠切除术的血管解剖与手术径路分析. 腹腔镜外科杂志, 2018, 23(5): 329-332.
22.	Gagner M, Pomp A. Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg, 1997, 1(1): 20-25.
23.	Boggi U, Amorese G, Vistoli F, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc, 2015, 29(1): 9-23.
24.	Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg, 2015, 220(4): 530-536.
25.	张亚武, 王哲元, 权柯, 等. 腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效对比分析. 中国普外基础与临床杂志, 2015, 25(9): 1078-1082.
26.	Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
27.	严力锋, 王钊, 洪德飞, 等. 腹腔镜胰十二指肠切除术进展. 中华肝胆外科杂志, 2008, 14(11): 828-830.
28.	苗毅, 高文涛. 腹腔镜胰十二指肠切除的规范化相关问题. 中华普外科手术学杂志: 电子版, 2015, 9(4): 240-242.
29.	李非, 彭承宏, 戴梦华. 胰头癌根治性切除: 开腹与腹腔镜手术的合理选择. 中国实用外科杂志, 2017, 37(7): 766-767.

1. 彭兵, 王明俊. 腹腔镜胰十二指肠切除术的历史与现状. 中国普外基础与临床杂志, 2016, 23(4): 385-387.
2. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
3. 洪德飞. 腹腔镜胰腺切除术发展机遇与挑战. 浙江医学, 2017, 39(22): 1943-1947.
4. Sally G, Julian PH, Philip A, et al. Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration, 2008.
5. Zureikat AH, Breaux JA, Steel JL, et al. Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg, 2011, 15(7): 1151-1157.
6. 卫洪波, 魏波, 郑宗珩, 等. 腹腔镜与开放胰十二指肠切除术疗效的对比观察. 中华胃肠外科杂志, 2014, 17(5): 465-468.
7. Hakeem AR, Verbeke CS, Cairns A, et al. A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol. Hepatobiliary Pancreat Dis Int, 2014, 13(4): 435-441.
8. Tan CL, Zhang H, Peng B, et al. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol, 2015, 21(17): 5311-5319.
9. 魏秋亚, 刘永永, 闫卫峰, 等. 全腹腔镜与开腹胰十二指肠切除术的临床配对研究. 中华肝胆外科杂志, 2016, 22(5): 332-335.
10. Khaled YS, Fatania K, Barrie J, et al. Matched case-control comparative study of laparoscopic versus open pancreaticoduodenectomy for malignant lesions. Surg Laparosc Endosc Percutan Tech, 2018, 28(1): 47-51.
11. Conrad C, Basso V, Passot G, et al. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. Surg Endosc, 2017, 31(10): 3970-3978.
12. 王文斌, 闫长青, 吕海涛, 等. 腹腔镜与开腹胰十二指肠切除术疗效分析. 中华肝胆外科杂志, 2017, 23(2): 110-113.
13. 吴万龙, 王明俊, 蔡云强, 等. 腹腔镜与开腹胰十二指肠切除术近期疗效的对比研究. 外科理论与实践, 2017, 22(2): 123-128.
14. 符真, 张剑权, 陈汉宗. 腹腔镜与开放手术方式在胰十二指肠切除术中的应用比较. 广东医学, 2017, 38(15): 2367-2370.
15. 李方宽, 王小明, 孙卫东, 等. 腹腔镜和开腹胰十二指肠切除术的近期临床疗效对比. 皖南医学院学报, 2017, 36(6): 535-538.
16. 王哲元, 张亚武, 权柯. 腹腔镜与传统手术治疗胆总管下段癌的临床疗效对比. 医学研究杂志, 2017, 46(12): 143-148.
17. Chen XM, Sun DL, Zhang Y. Laparoscopic versus open pancreaticoduodenectomy combined with uncinated process approach: a comparative study evaluating perioperative outcomes (retrospective cohort study). Int J Surg, 2018, 51: 170-173.
18. Cai Y, Gao P, Li Y, et al. Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc, 2018, 32(10): 4209-4215.
19. 金巍巍, 徐晓武, 牟一平, 等. 腹腔镜胰十二指肠切除术单中心 233 例临床经验总结. 中华外科杂志, 2017, 55(5): 354-358.
20. 刘学青, 邢中强, 秦建章, 等. 腹腔镜胰十二指肠切除术单中心 300 例临床分析. 中国实用外科杂志, 2018, 38(3): 306-311.
21. 姜翀弋, 王巍. 腹腔镜胰十二指肠切除术的血管解剖与手术径路分析. 腹腔镜外科杂志, 2018, 23(5): 329-332.
22. Gagner M, Pomp A. Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg, 1997, 1(1): 20-25.
23. Boggi U, Amorese G, Vistoli F, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc, 2015, 29(1): 9-23.
24. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg, 2015, 220(4): 530-536.
25. 张亚武, 王哲元, 权柯, 等. 腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效对比分析. 中国普外基础与临床杂志, 2015, 25(9): 1078-1082.
26. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
27. 严力锋, 王钊, 洪德飞, 等. 腹腔镜胰十二指肠切除术进展. 中华肝胆外科杂志, 2008, 14(11): 828-830.
28. 苗毅, 高文涛. 腹腔镜胰十二指肠切除的规范化相关问题. 中华普外科手术学杂志: 电子版, 2015, 9(4): 240-242.
29. 李非, 彭承宏, 戴梦华. 胰头癌根治性切除: 开腹与腹腔镜手术的合理选择. 中国实用外科杂志, 2017, 37(7): 766-767.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Total laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy: a meta-analysis based on non-RCT studies

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