Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2019; 25(37): 5711-5731
Published online Oct 7, 2019. doi: 10.3748/wjg.v25.i37.5711
Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis
Hua Zhang, Xiang Lan, Bing Peng, Bo Li
Hua Zhang, Xiang Lan, Bo Li, Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Bing Peng, Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang H, Lan X, Peng B, and Li B designed the research; Zhang H, Lan X, and Peng B performed the research and acquired the data; Zhang H, Lan X, and Li B analyzed and interpreted the data; Zhang H and Lan X drafted the article; Peng B and Li B proofread and revised the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of authors in this manuscript.
PRISMA 2009 Checklist statement: We have read the PRISMA 2009 checklist, and the manuscript was prepared and revised in accordance with the PRISMA 2009 checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bo Li, MD, PhD, Professor, Surgeon, Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, 37 Guoxue Road, Wuhou District, Chengdu 610041, Sichuan Province, China. libohuaxi@163.com
Telephone: +86-18980601470 Fax: +86-28-85423724
Received: April 15, 2019
Peer-review started: April 15, 2019
First decision: June 16, 2019
Revised: July 10, 2019
Accepted: August 7, 2019
Article in press: August 7, 2019
Published online: October 7, 2019
ARTICLE HIGHLIGHTS
Research background

Total laparoscopic pancreaticoduodenectomy (TLPD) has been performed and grew in popularity among the general surgeons in some major medical centers worldwide. Studies about its safety and feasibility have been reported, but considering the research characteristics and study size, controversies regarding its perioperative and oncological safey still exist.

Research motivation

We hope to offer higher quality and more relible evidence in the selection of clinical treatment options for patients with pancreatic head or periampullary lesions.

Research objectives

To help identify which operation method is suitable and beneficial for patients with pancreatic head or periampullary lesions.

Research methods

A systematic search was conducted in PubMed, EMBASE and Cochrane Library databases for studies concerning TLPD and open pancreaticoduodenectomy (OPD) for patients with pancreatic head or periampullary lesions. We followed the Preferred Reporting Items for Systematic Reviews and the PRISMA agreement, and and protocol can be accessed at the International Prospective Register of Systematic Reviews (registration number: CRD42019126173). The meta-analysis was performed using Review Manager Software version 5.3, and the quality was assessed using the Newcastle-Ottawa scale for the nonrandomized controlled trials and the Jadad scale for the randomized controlled trials.

Research results

Twenty-eight studies were eligible and selected in our analysis, including 3543 patients in the TLPD group and 36228 patients in the OPD group. Estimated blood loss (P < 0.00001) was less, intraoperative blood transfusion (P < 0.00001) and wound infection rate (P = 0.005) were lower, intensive care unit stay (P < 0.00001), length of hispital stay (P < 0.00001), and diet start time (P = 0.04) were shorter, R0 resection rate was higher (P = 0.02), and more lymph nodes was harvested (P = 0.01) in the TLPD group, although the operative time was longer (P < 0.00001) and the tumor size was smaller (P = 0.008). The overall morbidity, reoperation rate, and mortality showed no significant difference between the TLPD group and the OPD group. Moreover, the overall survival and recurrence-free survival afterTLPD were similar to those after OPD.

Research conclusions

The current meta-analysis showed that TLPD may be an ideal alternative option for patients with pancreatic head or periampullary lesions and it can be beneficial for patiets.

Research perspectives

The results of the current meta-analysis may offer surgeons more reliable evidence in choosing the surgery options for patients with pancreatic head or periampullary lesions.