Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a Meta-analysis

doi:10.3877/cma.j.issn.1674-6899.2021.01.009

Abstract

Abstract:

Objective

Comparison of the safety and efficacy of laparoscopic and open distal pancreatectomy in the treatment of pancreatic ductal adenocarcinoma.

Methods

The published clinical studies including laparoscopic distal pancreatectomy(LDP) and open distal pancreatectomy(ODP) in treatment of pancreatic ductal adneocarcinoma(PDAC) before Oct. 2020 were reviewed. After screening, the included literature was subjected to quality evaluation and data extraction, and then, statistical analysis was performed using review manager(RevMan) 5.3 software.

Results

Fifteen studies with a total of 5 343 patients(1 396 in LDP and 3 947 in ODP) were included for the meta-analysis.LDP showed less blood loss(weighted mean difference, WMD)=-112.44, 95%CI(confidence interval, CI): -193.06-31.82, P=0.006), lower blood transfusion rate(OR=0.33, 95%CI: 0.23-0.49, P<0.000 01), shorter hospitalization time(WMD=-3.35, 95%CI: -4.57--2.13, P<0.000 01), higher R0 resection rate(OR=1.30, 95%CI: 1.04-1.64, P=0.02), higher 3-year overall survival(HR=0.84, 95%CI: 0.76-0.92, P=0.000 4) and 5-year overall survival(HR=0.82, 95%CI: 0.74-0.92, P=0.000 8).

Conclusions

LDP has advantages over ODP in terms of intraoperative bleeding, transfusion rates, and length of stay in the treatment of PDAC in the body and tail of the pancreas, and also has oncologic outcomes that are not inferior to those of ODP.Given the limitations of this study, this result still needs to be confirmed in a large prospective randomized controlled study.

Key words: Laparoscopy, Distal pancreatectomy, Pancreatic ductal adenocarcinoma, Meta-analysis

Yong Jia, Hongyang Liu, Binru Zhang, Linfeng Li, Haonian Wang, Hua Chen, Bei Sun. Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a Meta-analysis[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(01): 37-43.

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References 37

1	Cuschieri A. Laparoscopic surgery of the pancreas[J]. Journal of the Royal College of Surgeons of Edinburgh, 1994, 39(3): 178-184.
2	Sahakyan MA, Kim SC, Kleive D, et al. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: long-term oncologic outcomes after standard resection[J]. Surgery (United States), 2017, 162(4): 802-811.
3	Riviere D, Gurusamy KS, Kooby DA, et al. Laparoscopic versus open distal pancreatectomy for pancreatic cancer[J]. Cochrane Database of Systematic Reviews, 2016, 4(4): CD011391. DOI: 10.1371/journal.pone.0189631
4	Rooij T, Besselink MG, Shamali A, et al. Pan-european survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer[J]. HPB : the official journal of the International Hepato Pancreato Biliary Association, 2016, 18(2): 170-176.
5	Kwon W, Jang JY, Park JW, et al. Which method of pancreatic surgery do medical consumers prefer among open, laparoscopic, or robotic surgery: a survey[J]. Annals of surgical treatment and research, 2014, 86(1): 7-15.
6	Hilst J, Korrel M, Rooij T, et al. Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis[J]. European Journal of Surgical Oncology, 2019, 45(5): 719-727.
7	Yang DJ, Xiong JJ, Lu HM, et al. The oncological safety in minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis[J]. Scientific reports, 2019, 9(1): 1159. DOI: 10.1038/s41598-018-37617-0.
8	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample[J]. BMC medical research methodology, 2005, 5: 13. DOI: 10.1186/1471-2288-5-13.
9	Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis[J]. Trials, 2007, 8: 16. DOI: 10.1186/1745-6215-8-16.
10	Bauman MD, Becerra DG, Kilbane EM, et al. Laparoscopic distal pancreatectomy for pancreatic cancer is safe and effective[J]. Surgical endoscopy, 2018, 32(1): 53-61.
11	Kantor O, Bryan DS, Talamonti MS, et al. Laparoscopic distal pancreatectomy for cancer provides oncologic outcomes and overall survival identical to open distal pancreatectomy[J]. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2017, 21(10): 1620-1625.
12	Raoof M, Ituarte PHG, Woo Y, et al. Propensity score-matched comparison of oncological outcomes between laparoscopic and open distal pancreatic resection[J]. The British journal of surgery, 2018, 105(5): 578-586.
13	Sharpe SM, Talamonti MS, Wang E, et al. The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes[J]. American journal of surgery, 2015, 209(3): 557-563.
14	Kooby DA, Hawkins WG, Schmidt CM, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate[J]. Journal of the American College of Surgeons, 2010, 210(5): 779-785.
15	Hu M, Zhao G, Wang F, et al. Laparoscopic versus open distal splenopancreatectomy for the treatment of pancreatic body and tail cancer: a retrospective, mid-term follow-up study at a single academic tertiary care institution[J]. Surgical endoscopy, 2014, 28(9): 2584-2591.
16	Rehman S, John SK, Lochan R, et al. Oncological feasibility of laparoscopic distal pancreatectomy for adenocarcinoma: a single-institution comparative study[J]. World journal of surgery, 2014, 38(2): 476-483.
17	Braga M, Pecorelli N, Ferrari D, et al. Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment[J]. Surgical endoscopy, 2015, 29(7): 1871-1878.
18	Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: a single institution′s experience in open, laparoscopic, and robotic approaches[J]. Journal of the American College of Surgeons, 2015, 220(1): 18-27.
19	Shin SH, Kim SC, Song KB, et al. A comparative study of laparoscopic vs open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis[J]. Journal of the American College of Surgeons, 2015, 220(2): 177-185.
20	Sulpice L, Farges O, Goutte N, et al. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma[J]. Annals of surgery, 2015, 262(5): 868-874.
21	Zhang M, Fang R, Mou Y, et al. LDP vs ODP for pancreatic adenocarcinoma: a case matched study from a single-institution[J]. BMC gastroenterology, 2015, 15(1): 1-8.
22	Stauffer JA, Coppola A, Mody K, et al. Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma[J]. World journal of surgery, 2016, 40(6): 1477-1484.
23	Joliat GR, Demartines N, Halkic N, et al. Short-term outcomes after distal pancreatectomy: laparotomy vs. laparoscopy - a single-center series[J]. Annals of medicine and surgery (2012), 2017, 13(3): 1-5.
24	Wellner UF, Lapshyn H, Bartsch DK, et al. Laparoscopic versus open distal pancreatectomy—a propensity score-matched analysis from the german studoq\|pancreas registry[J]. International journal of colorectal disease, 2017, 32(2): 273-280.
25	Zhang AB, Wang Y, Hu C, et al. Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a single-center experience[J]. Journal of Zhejiang University: Science B, 2017, 18(6): 532-538.
26	Jarufe N, Soto P, Ahumada V, et al. Laparoscopic versus open distal pancreatectomy: comparative analysis of clinical outcomes at a single institution[J]. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, 2018, 28(1): 62-66.
27	Chen K, Tong Q, Yan JF, et al. Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a single-center propensity score matching study[J]. Updates in surgery, 2020, 72(2): 387-397.
28	Watson MD, Baimas-George MR, Thompson KJ, et al. Improved oncologic outcomes for minimally invasive left pancreatectomy: propensity-score matched analysis of the national cancer database[J]. Journal of surgical oncology, 2020, 122(7): 1-10.
29	Björnsson B, Larsson AL, Hjalmarsson C, et al. Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial[J]. The British journal of surgery, 2020, 107(10): 1281-1288.
30	Sahakyan MA, Kim SC, Kleive D, et al. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: long-term oncologic outcomes after standard resection[J]. Surgery, 2017, 162(4): 802-811.
31	Gavriilidis P, Roberts KJ, Sutcliffe RP. Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma: a systematic review and meta-analysis[J]. Acta chirurgica Belgica, 2018, 118(5): 278-286.
32	Kazaryan AM, Solberg I, Aghayan DL, et al. Does tumor size influence the outcome of laparoscopic distal pancreatectomy[J]. HPB, 2020, 22(9): 1280-1287.
33	Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy[J]. Surgery, 2003, 133(5): 521-527.
34	Abe T, Ohuchida K, Miyasaka Y, et al. Comparison of surgical outcomes between radical antegrade modular pancreatosplenectomy (RAMPS) and standard retrograde pancreatosplenectomy (SPRS) for left-sided pancreatic cancer[J]. World journal of surgery, 2016, 40(9): 2267-2275.
35	Kim EY, Hong TH. Initial experience with laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer in a single institution: technical aspects and oncological outcomes[J]. BMC surgery, 2017, 17(1): 2. DOI: 10.1186/s12893-016-0200-z
36	Kiguchi G, Sugioka A, Kato Y, et al. Laparoscopic distal pancreatectomy with regional lymphadenectomy through retroperitoneal-first laparoscopic approach (Retlap) for locally advanced pancreatic body cancer[J]. Surgical oncology, 2020, 35: 301-302. DOI: 10.1016/j.suronc.2020.07.008
37	Harlaar JJ, Gosselink MP, Hop WC, et al. Blood transfusions and prognosis in colorectal cancer: long-term results of a randomized controlled trial[J]. Annals of surgery, 2012, 256(5): 681-686.

作者	年份	评分(分)								总评分(分)
作者	年份	①	②	③	④	⑤	⑥	⑦	⑧	总评分(分)
Kooby等^{[ 14 ]}	2010	1	1	1	1	1	1	1	1	8
Hu等^{[ 15 ]}	2014	1	1	1	1	1	1	1	1	8
Rehamn等^{[ 16 ]}	2014	1	1	1	1	1	1	1	1	8
Braga等^{[ 17 ]}	2015	1	1	1	1	1	1	0	0	6
Lee等^{[ 18 ]}	2015	1	1	1	1	1	1	0	0	6
Shin等^{[ 19 ]}	2015	1	1	1	1	1	1	1	1	8
Sulipice等^{[ 20 ]}	2015	1	1	1	1	1	1	1	1	8
Zhang等^{[ 21 ]}	2015	1	1	1	1	2	1	1	1	9
Stauffer等^{[ 22 ]}	2016	1	1	1	1	1	1	1	1	8
Joliat等^{[ 23 ]}	2017	1	1	1	1	1	1	0	0	6
Wellner等^{[ 24 ]}	2017	1	1	1	1	2	1	0	0	7
Zhang等^{[ 25 ]}	2017	1	1	1	1	2	1	1	1	9
Jarufe等^{[ 26 ]}	2018	1	1	1	1	1	1	1	1	8
Chen等^{[ 27 ]}	2020	1	1	1	1	2	1	1	1	9
Watson等^{[ 28 ]}	2020	1	1	1	1	2	1	1	1	9

作者	年份	评分(分)								总评分(分)
作者	年份	①	②	③	④	⑤	⑥	⑦	⑧	总评分(分)
Kooby等^{[ 14 ]}	2010	1	1	1	1	1	1	1	1	8
Hu等^{[ 15 ]}	2014	1	1	1	1	1	1	1	1	8
Rehamn等^{[ 16 ]}	2014	1	1	1	1	1	1	1	1	8
Braga等^{[ 17 ]}	2015	1	1	1	1	1	1	0	0	6
Lee等^{[ 18 ]}	2015	1	1	1	1	1	1	0	0	6
Shin等^{[ 19 ]}	2015	1	1	1	1	1	1	1	1	8
Sulipice等^{[ 20 ]}	2015	1	1	1	1	1	1	1	1	8
Zhang等^{[ 21 ]}	2015	1	1	1	1	2	1	1	1	9
Stauffer等^{[ 22 ]}	2016	1	1	1	1	1	1	1	1	8
Joliat等^{[ 23 ]}	2017	1	1	1	1	1	1	0	0	6
Wellner等^{[ 24 ]}	2017	1	1	1	1	2	1	0	0	7
Zhang等^{[ 25 ]}	2017	1	1	1	1	2	1	1	1	9
Jarufe等^{[ 26 ]}	2018	1	1	1	1	1	1	1	1	8
Chen等^{[ 27 ]}	2020	1	1	1	1	2	1	1	1	9
Watson等^{[ 28 ]}	2020	1	1	1	1	2	1	1	1	9

结局指标	纳入研究数量	异质性		总体结果	95%CI	P值
结局指标	纳入研究数量	P值	I²值	总体结果	95%CI	P值
年龄	8	0.007	64%	WMD＝-1.68	-3.96～0.61	0.15
体质量指数	7	0.009	65%	WMD＝0.66	-0.05～1.36	0.07
手术时间	8	<0.000 1	79%	WMD＝5.21	-16.97～27.38	0.65
术后胰瘘	5	0.970	0%	OR＝1.69	0.99～2.91	0.06
临床相关胰瘘	6	0.550	0%	OR＝1.12	0.62～2.01	0.70
Clavien-DindoⅢ级以上并发症发生率	4	0.330	12%	OR＝0.60	0.29～1.22	0.16
术后辅助治疗时间	3	0.004	82%	WMD＝-4.33	-9.46～0.81	0.10
术后辅助化疗患者例数	5	0.720	0%	OR＝1.11	0.91～1.34	0.30

结局指标	纳入研究数量	异质性		总体结果	95%CI	P值
结局指标	纳入研究数量	P值	I²值	总体结果	95%CI	P值
年龄	8	0.007	64%	WMD＝-1.68	-3.96～0.61	0.15
体质量指数	7	0.009	65%	WMD＝0.66	-0.05～1.36	0.07
手术时间	8	<0.000 1	79%	WMD＝5.21	-16.97～27.38	0.65
术后胰瘘	5	0.970	0%	OR＝1.69	0.99～2.91	0.06
临床相关胰瘘	6	0.550	0%	OR＝1.12	0.62～2.01	0.70
Clavien-DindoⅢ级以上并发症发生率	4	0.330	12%	OR＝0.60	0.29～1.22	0.16
术后辅助治疗时间	3	0.004	82%	WMD＝-4.33	-9.46～0.81	0.10
术后辅助化疗患者例数	5	0.720	0%	OR＝1.11	0.91～1.34	0.30

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