TY - JOUR
T1 - Minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma
T2 - Individual patient data meta-analysis of randomized trials
AU - Uijterwijk, Bas A.
AU - Wei, Kongyuan
AU - Kasai, Meidai
AU - Ielpo, Benedetto
AU - Hilst, Jony van
AU - Chinnusamy, Palanivelu
AU - Lemmers, Daniel H. L.
AU - Burdio, Fernando
AU - Senthilnathan, Palanisamy
AU - Besselink, Marc G.
AU - Abu Hilal, Mohammed
AU - Qin, Renyi
N1 - Funding Information: Despite receiving funding from an industry grant for investigator-initiated studies, Van Hilst et al. reported that the trial was unaffected by this. In their trial registration, Poves et al. stated that they had “no unique source of money for performing these surgeries.” The “ GEM Hospital & Research Center ” funded Palanivelu et al. in their article. According to Wang et al., “ National Natural Science Foundation of China and Tongji Hospital ” supported the trial. No conflicts of interest were mentioned in any studies. Publisher Copyright: © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Objective: Assessment of minimally invasive pancreatoduodenectomy (MIPD) in patients with pancreatic ductal adenocarcinoma (PDAC) is scarce and limited to non-randomized studies. This study aimed to compare oncological and surgical outcomes after MIPD compared to open pancreatoduodenectomy (OPD) for patients after resectable PDAC from published randomized controlled trials (RCTs). Methods: A systematic review was performed to identify RCTs comparing MIPD and OPD including PDAC (Jan 2015–July 2021). Individual data of patients with PDAC were requested. Primary outcomes were R0 rate and lymph node yield. Secondary outcomes were blood-loss, operation time, major complications, hospital stay and 90-day mortality. Results: Overall, 4 RCTs (all addressed laparoscopic MIPD) with 275 patients with PDAC were included. In total, 128 patients underwent laparoscopic MIPD and 147 patients underwent OPD. The R0 rate (risk difference(RD) −1%, P = 0.740) and lymph node yield (mean difference(MD) +1.55, P = 0.305) were comparable between laparoscopic MIPD and OPD. Laparoscopic MIPD was associated with less perioperative blood-loss (MD -91ml, P = 0.026), shorter length of hospital stay (MD -3.8 days, P = 0.044), while operation time was longer (MD +98.5 min, P = 0.003). Major complications (RD -11%, P = 0.302) and 90-day mortality (RD -2%, P = 0.328) were comparable between laparoscopic MIPD and OPD. Conclusions: This individual patient data meta-analysis of MIPD versus OPD in patients with resectable PDAC suggests that laparoscopic MIPD is non-inferior regarding radicality, lymph node yield, major complications and 90-day mortality and is associated with less blood loss, shorter hospital stay, and longer operation time. The impact on long-term survival and recurrence should be studied in RCTs including robotic MIPD.
AB - Objective: Assessment of minimally invasive pancreatoduodenectomy (MIPD) in patients with pancreatic ductal adenocarcinoma (PDAC) is scarce and limited to non-randomized studies. This study aimed to compare oncological and surgical outcomes after MIPD compared to open pancreatoduodenectomy (OPD) for patients after resectable PDAC from published randomized controlled trials (RCTs). Methods: A systematic review was performed to identify RCTs comparing MIPD and OPD including PDAC (Jan 2015–July 2021). Individual data of patients with PDAC were requested. Primary outcomes were R0 rate and lymph node yield. Secondary outcomes were blood-loss, operation time, major complications, hospital stay and 90-day mortality. Results: Overall, 4 RCTs (all addressed laparoscopic MIPD) with 275 patients with PDAC were included. In total, 128 patients underwent laparoscopic MIPD and 147 patients underwent OPD. The R0 rate (risk difference(RD) −1%, P = 0.740) and lymph node yield (mean difference(MD) +1.55, P = 0.305) were comparable between laparoscopic MIPD and OPD. Laparoscopic MIPD was associated with less perioperative blood-loss (MD -91ml, P = 0.026), shorter length of hospital stay (MD -3.8 days, P = 0.044), while operation time was longer (MD +98.5 min, P = 0.003). Major complications (RD -11%, P = 0.302) and 90-day mortality (RD -2%, P = 0.328) were comparable between laparoscopic MIPD and OPD. Conclusions: This individual patient data meta-analysis of MIPD versus OPD in patients with resectable PDAC suggests that laparoscopic MIPD is non-inferior regarding radicality, lymph node yield, major complications and 90-day mortality and is associated with less blood loss, shorter hospital stay, and longer operation time. The impact on long-term survival and recurrence should be studied in RCTs including robotic MIPD.
KW - HPB surgery
KW - Minimally invasive pancreatoduodenectomy
KW - Minimally invasive surgery
KW - Open pancreatoduodenectomy
KW - Pancreatic ductal adenocarcinoma
KW - Pancreatoduodenectomy
UR - http://www.scopus.com/inward/record.url?scp=85152656932&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2023.03.227
DO - https://doi.org/10.1016/j.ejso.2023.03.227
M3 - Review article
C2 - 37076411
SN - 0748-7983
VL - 49
SP - 1351
EP - 1361
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 8
ER -