Laparoscopic Versus Open Pancreatoduodenectomy for Periampullary Tumors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2024-09-01 Epub Date: 2024-07-19 DOI:10.1007/s12029-024-01091-x

Pedro C A Reis, Vinicius Bittar, Giulia Almirón, Ana Júlia Schramm, João Pedro Oliveira, Renato Cagnacci, Marcos P G Camandaroba

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引用次数: 0

Abstract

Purpose: Laparoscopic pancreatoduodenectomy (LPD) has emerged as an alternative to open technique in treating periampullary tumors. However, the safety and efficacy of LPD compared to open pancreatoduodenectomy (OPD) remain unclear. Thus, we conducted an updated meta-analysis to evaluate the efficacy and safety of LPD versus OPD in patients with periampullary tumors, with a particular focus on the pancreatic ductal adenocarcinoma patient subgroup.

Methods: According to PRISMA guidelines, we searched PubMed, Embase, and Cochrane Library in December 2023 for randomized controlled trials (RCTs) that directly compare LPD versus OPD in patients with periampullary tumors. Endpoints and sensitive analysis were conducted for short-term endpoints. All statistical analysis was performed using R software version 4.3.1 with a random-effects model.

Results: Five RCTs yielding 1018 patients with periampullary tumors were included, of whom 511 (50.2%) were randomized to the LPD group. Total follow-up time was 90 days. LPD was associated with a longer operation time (MD 66.75; 95% CI 26.59 to 106.92; p = 0.001; I² = 87%; Fig. 1A), lower intraoperative blood loss (MD - 124.05; 95% CI - 178.56 to - 69.53; p < 0.001; I² = 86%; Fig. 1B), and shorter length of stay (MD - 1.37; 95% IC - 2.31 to - 0.43; p = 0.004; I² = 14%; Fig. 1C) as compared with OPD. In terms of 90-day mortality rates and number of lymph nodes yield, no significant differences were found between both groups.

Conclusion: Our meta-analysis of RCTs suggests that LPD is an effective and safe alternative for patients with periampullary tumors, with lower intraoperative blood loss and shorter length of stay.

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腹腔镜与开腹胰十二指肠切除术治疗胰腺周围肿瘤：随机对照试验的系统回顾和元分析》。

目的：腹腔镜胰十二指肠切除术（LPD）已成为治疗胰腺周围肿瘤的开腹技术的替代方法。然而，与开腹胰十二指肠切除术（OPD）相比，腹腔镜胰十二指肠切除术的安全性和有效性仍不明确。因此，我们进行了一项最新的荟萃分析，评估LPD与OPD在胰腺周围肿瘤患者中的疗效和安全性，尤其关注胰腺导管腺癌患者亚组：根据PRISMA指南，我们在2023年12月检索了PubMed、Embase和Cochrane图书馆中直接比较胰腺周围肿瘤患者LPD与OPD的随机对照试验（RCT）。终点和敏感性分析针对短期终点进行。所有统计分析均使用 R 软件 4.3.1 版和随机效应模型进行：结果：共纳入了5项RCT，1018例胰周肿瘤患者，其中511例（50.2%）被随机分配到LPD组。总随访时间为90天。与 OPD 相比，LPD 的手术时间更长（MD 66.75；95% CI 26.59 至 106.92；p = 0.001；I2 = 87%；图 1A），术中失血量更少（MD - 124.05；95% CI - 178.56 至 - 69.53；p 2 = 86%；图 1B），住院时间更短（MD - 1.37；95% IC - 2.31 至 - 0.43；p = 0.004；I2 = 14%；图 1C）。在 90 天死亡率和淋巴结数量方面，两组之间没有发现显著差异：我们对 RCT 进行的荟萃分析表明，LPD 是胰周肿瘤患者的一种有效且安全的选择，术中失血较少，住院时间较短。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.