Published online Oct 7, 2019. doi: 10.3748/wjg.v25.i37.5711
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
Processing time: 169 Days and 13.5 Hours
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.
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.
To help identify which operation method is suitable and beneficial for patients with pancreatic head or periampullary lesions.
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.
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.
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.
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.