AUTHOR=Yan Yong , Hua Yinggang , Chang Cheng , Zhu Xuanjin , Sha Yanhua , Wang Bailin 

TITLE=Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1093395

DOI=10.3389/fonc.2022.1093395

ISSN=2234-943X

ABSTRACT=Objective: This meta-analysis compares perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to open pancreaticoduodenectomy (OPD) for pancreatic and periampullary tumor.
Background: LPD has been increasingly applied in the treatment of pancreatic and periampullary tumor. However, the perioperative outcomes of LPD versus OPD are still controversial.
Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched to identify RCTs and nonrandomized comparative studies (NRCTs) compared LPD versus OPD for pancreatic and periampullary tumor. Main outcomes were mortality, morbidity, serious complications, and hospital stay. Secondary outcomes were operative time, blood loss, transfusion, postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), bile leak (BL), delayed gastric emptying (DGE), lymph nodes harvested, R0 resection, reoperation, and readmission. RCTs were evaluated by Cochrane risk of bias tool. NRCTs were assessed using a modified tool from the Methodological Index for Nonrandomized Studies. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42022338832).
Results: Four RCTs and 35 NRCTs concerning total 40230 patients (4262 LPD, 35968 OPD) were included. Meta-analyses showed no significant differences in mortality (OR 0.91, P = 0.35), serious complications (OR 0.97, P = 0.74), POPF (OR 0.93, P = 0.29), PPH (OR 1.10, P = 0.42), BL (OR 1.28, P = 0.22), harvested lymph nodes (MD 0.66, P = 0.09), reoperation (OR 1.10, P = 0.41), and readmission (OR 0.95, P = 0.46) between LPD and OPD. Operative time was significantly longer for LPD (MD 85.59 minutes, P < 0.00001), whereas overall morbidity (OR 0.80, P < 0.00001), hospital stay (MD -2.32 days, P < 0.00001), blood loss (MD -173.84 mL, P < 0.00001), transfusion (OR 0.62, P = 0.0002) and DGE (OR 0.78, P = 0.002) were reduced for LPD. The R0 rate was higher for LPD (OR 1.25, P = 0.001). 
Conclusions: LPD is associated with noninferior short-term surgical outcomes and oncological adequacy compared to OPD when performed by experienced surgeon at large center. LPD may result in reduced overall morbidity, blood loss, transfusion, and DGE, but longer operative time. Further RCTs should address the potential advantages of LPD over OPD.