Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis

doi:10.3748/wjg.v25.i37.5711

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 25, Issue 37

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (10558)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-2) series, Tables (1-4) series.

Item

Count

PDF

640

WORD

257

HTML

6005

Figures (1-2)

325

Tables (1-4)

304

Sum=7531

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

961

Download

2066

Sum=3027

Oct 7, 2019 (publication date) through Mar 6, 2025

Times Cited of This Article

Times Cited (37)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis

World J Gastroenterol. Oct 7, 2019; 25(37): 5711-5731
Published online Oct 7, 2019. doi: 10.3748/wjg.v25.i37.5711

Table 1 Characteristics of 28 included studies.

First author	Year	Country	Study design	Sample size		Conver-sion n (%)	ISGPF	ISGPS	Clavien-Dindo	Quali-ty Scor-es
First author	Year	Country	Study design	TLPD	OPD	Conver-sion n (%)	ISGPF	ISGPS	Clavien-Dindo	Quali-ty Scor-es
Zimmerman	2018	USA	Retrospective analysis	280	6336	78 (27.86)	NR	NR	NR	7^a
Tran	2016	USA	Retrospective analysis	681	14893	NR	NR	NR	NR	7^a
Tee	2015	USA	Retrospective analysis	113	225	NR	YES	YES	YES	8^a
Tan	2015	China	Retrospective analysis	30	30	NR	YES	YES	NR	9^a
Stauffer	2017	USA	Retrospective analysis	58	193	NR	YES	YES	YES	8^a
Song	2015	Korea	Matched case-control study	97	198	NR	YES	YES	YES	8^a
Sharpe	2015	USA	Retrospective analysis	384	4037	NR	NR	NR	NR	7^a
Senthilna-than	2015	India	Retrospective analysis	45	118	NR	NR	NR	NR	8^a
Poves	2018	Spain	RCT	32	29	8 (25.00)	YES	YES	YES	4^b
Palanivelu	2017	India	RCT	32	32	1 (3.13)	YES	YES	YES	3^b
Meng	2018	China	Retrospective analysis	58	58	NR	YES	YES	YES	9^a
Lee	2018	Korea	Matched case-control study	31	31	NR	NR	NR	NR	9^a
Khaled	2018	UK	Matched case-control study	15	15	1 (6.67)	YES	YES	YES	9^a
Kantor	2017	USA	Retrospective analysis	828	7385	NR	NR	NR	NR	7^a
Hakeem	2014	UK	Matched case-control study	12	12	NR	NR	NR	YES	9^a
Gerber	2017	USA	Retrospective analysis	52	50	NR	NR	NR	NR	8^a
Dokmak	2015	France	Matched case-control study	46	46	3 (6.52)	YES	YES	YES	9^a
Delitto	2016	USA	Retrospective analysis	52	50	NR	YES	YES	YES	8^a
Croome	2014	USA	Retrospective analysis	108	214	7 (6.48)	YES	YES	YES	8^a
Conrad	2017	USA	Retrospective analysis	40	25	9 (22.50)	YES	YES	YES	8^a
Chopinet	2018	France	Retrospective analysis	65	290	NR	YES	YES	YES	8^a
Chen	2018	China	Retrospective analysis	47	55	NR	YES	YES	YES	8^a
Chapman	2018	USA	Retrospective analysis	22	25	0 (0)	YES	YES	YES	8^a
Chapman	2018	USA	Retrospective analysis	248	1520	74 (29.84)	NR	NR	NR	7^a
Asbun	2012	USA	Retrospective analysis	53	215	9 (15.00)	YES	YES	NR	8^a
Zureikat	2011	USA	Matched case-control study	14	14	2 (14.29)	YES	NR	YES	9^a
Mesleh	2013	USA	Retrospective analysis	75	48	10 (13.33)	YES	YES	YES	8^a
Speicher	2014	USA	Retrospective analysis	25	84	NR	YES	NR	NR	8^a

^aNewcastle-Ottawa scale;

^bJadad scale. TLPD: Total laparoscopic pancreaticoduodenectomy; OPD: Open pancreaticoduodenectomy; ISGPF: International Study Group of Pancreatic Fistula; ISGPS: International Study Group on Pancreatic Surgery; Clavien-Dindo: The Clavien-Dindo Classification of Surgical Complications; RCT: Randomized controlled trial; NR: Not reported.

Table 2 Meta-analysis of intraoperative and perioperative results

Outcome of interest	No. of studies	Sample size		Heterogeneity		Model	Overall effect size	95%CI of overall effect	P-value
Outcome of interest	No. of studies	TLPD	OPD	P	I²	Model	Overall effect size	95%CI of overall effect	P-value
Operative time	11	642	1129	< 0.00001	99%	R	WMD = 77.92	40.89, 114.95	< 0.0001
EBL	10	612	1324	< 0.00001	98%	R	WMD = -260.08	-336.02, -184.14	< 0.00001
Transfusion rate	12	1254	15964	0.003	60%	R	OR = 0.51	0.36, 0.72	0.0001
Overall morbidity	12	1407	22126	0.10	37%	F	OR = 0.82	0.73, 0.92	0.0008
Major morbidity	16	886	1704	0.05	41%	F	OR = 0.88	0.70, 1.10	0.25
POPF	17	954	7629	0.42	3%	F	OR = 0.95	0.79, 1.15	0.62
POPF (grade B/C)	18	942	1821	0.47	0	F	OR = 0.96	0.76, 1.22	0.75
DGE	13	890	7452	0.98	0	F	OR = 0.99	0.78, 1.24	0.90
DGE (grade B/C)	7	479	994	0.60	0	F	OR = 0.63	0.45, 0.88	0.006
PPH	13	771	7363	0.74	0	F	OR = 1.12	0.89, 1.42	0.34
PPH (grade B/C)	7	454	966	0.91	0	F	OR = 1.02	0.65, 1.60	0.95
Bile leak	8	289	522	0.96	0	F	OR = 1.11	0.57, 2.16	0.76
Gastroente-ric anastomosis fistula	4	201	423	0.77	0	F	OR = 0.62	0.16, 2.40	0.49
Wound infection	10	612	7033	0.38	7%	F	OR = 0.48	0.34, 0.67	< 0.0001
Intra-abdominal abscess	6	455	6676	0.32	14%	F	OR = 0.97	0.71, 1.31	0.82
Bowel obstruction	2	73	73	0.33	0	F	OR = 1.00	0.14, 7.31	1.00
Fluid collection	3	142	367	0.20	37%	F	OR = 1.50	0.90, 2.48	0.12
Pneumonia	13	1489	22399	0.99	0	F	OR = 0.72	0.60, 0.85	0.0002
Cardiac event	6	1200	21877	0.75	0	F	OR = 1.04	0.82, 1.32	0.75
Reoperation	14	881	7616	0.40	5%	F	OR = 1.10	0.83, 1.47	0.51
ICU admission	2	171	283	0.40	0	F	OR = 0.90	0.53, 1.54	0.71
ICU stay	2	65	227	0.62	0	F	WMD = -2.08	-2.88, -1.29	< 0.00001
Diet Start Time	3	175	284	<0.0001	90%	R	WMD = -1.75	-3.38, -0.12	0.04
LOS	10	1544	11922	< 0.00001	78%	R	WMD = -3.05	-3.93, -2.17	< 0.00001
Discharge to a new facility	4	498	6826	0.74	0	F	OR = 0.55	0.39, 0.78	0.0008
30-d readmission	10	2006	19786	0.30	15%	F	OR = 0.81	0.68, 0.95	0.010
90-d readmission	4	136	279	0.70	0	F	OR = 1.07	0.62, 1.84	0.81
30-d mortality	18	2870	35337	0.70	0	F	OR = 1.00	0.81, 1.24	1.00
90-d mortality	11	1273	9159	0.77	0	F	OR = 0.77	0.58, 1.01	0.06

EBL: Estimated blood loss; Major morbidity: Clavien-Dindo classification ≥ III; POPF: Postoperative pancreatic fistula; DGE: Delayed gastric emptying; PPH: Postpancreatectomy hemorrhage; LOS: Length of hospital stay; ICU: Intensive care unit; WMD: Weighted mean difference; OR: Odds ratio; CI: Confidence interval; F: Fixed-effects model; R: Random-effects model; TLPD: Total laparoscopic pancreaticoduodenectomy; OPD: Open pancreaticoduodenectomy.

Table 3 Meta-analysis of oncological outcomes

Outcome of interest	No. of studies	Sample size		Heterogeneity		Model	Overall effect size	95%CI of overall effect	P-value
Outcome of interest		TLPD	OPD	P	I²	Model	Overall effect size	95%CI of overall effect	P-value
Tumor size	10	814	4782	< 0.00001	85%	R	WMD = -0.32	-0.58, -0.07	0.01
RLNs	12	1600	12347	< 0.00001	77%	R	WMD = 1.32	0.57, 2.06	0.0005
R0 rate	19	1991	14477	0.88	0	F	OR = 1.28	1.13, 1.44	0.0001
Time to adjuvant chemotherapy	2	867	7526	0.39	0	F	WMD = -2.44	-4.39, -0.49	0.01
RFS of all malignant tumor patients
1-yr RFS	2	52	37	NA	NA	F	OR = 0.44	0.16, 1.23	0.12
3-yr RFS	2	52	37	0.22	35%	F	OR = 0.53	0.19, 1.47	0.22
5-yr RFS	2	52	37	0.31	4%	F	OR = 0.40	0.12, 1.33	0.14
OS of all malignant tumor patients
1-yr OS	5	412	2206	0.007	72%	R	OR = 0.62	0.33, 1.19	0.15
2-yr OS	4	400	2194	0.03	66%	R	OR = 0.61	0.32, 1.17	0.14
3-yr OS	5	412	2206	0.08	51%	R	OR = 0.80	0.40, 1.62	0.54
4-yr OS	4	400	2194	0.60	0	F	OR = 0.73	0.41, 1.30	0.28
5-yr OS	6	520	2420	0.52	0	F	OR = 0.78	0.38, 1.59	0.49
OS of PDAC patients
1-yr OS	3	349	1947	0.28	22%	F	OR = 0.93	0.74, 1.18	0.57
2-yr OS	3	349	1947	0.21	37%	F	OR = 0.93	0.70, 1.24	0.63
3-yr OS	3	349	1947	0.60	0	F	OR = 0.86	0.56, 1.34	0.52
4-yr OS	3	349	1947	0.95	0	F	OR = 0.97	0.49, 1.92	0.94
5-yr OS	3	349	1947	0.27	17%	F	OR = 0.65	0.19, 2.23	0.49
OS of periampullary adenocarcinoma patients
1-yr OS	3	349	1947	0.28	22%	F	OR = 0.93	0.74, 1.18	0.57
2-yr OS	3	349	1947	0.21	37%	F	OR = 0.93	0.70, 1.24	0.63
3-yr OS	3	349	1947	0.60	0	F	OR = 0.86	0.56, 1.34	0.52
4-yr OS	3	349	1947	0.95	0	F	OR = 0.97	0.49, 1.92	0.94
5-yr OS	3	349	1947	0.27	17%	F	OR = 0.65	0.19, 2.23	0.49
5-yr OS	6	520	2420	0.52	0	F	OR = 0.78	0.38, 1.59	0.49

RLNs: Retrieved lymph nodes; RFS: Recurrence-free survival; OS: Overall survival; PDAC: Pancreatic ductal adenocarcinoma; OR: Odds Ratio; CI: Confidence interval; F: Fixed-effects model; R: Random-effects model; NA: Not applicable; TLPD: Total laparoscopic pancreaticoduodenectomy; OPD: Open pancreaticoduodenectomy.

Table 4 Results of sensitivity analysis of total laparoscopic pancreaticoduodenectomy vs open pancreaticoduodenectomy

Outcomes of interest	No. of Studies	Sample size		Heterogeneity		Model	Overall effect size	95%CI of overall effect	P-value
Outcomes of interest	No. of Studies	TLPD	OPD	P	I²	Model	Overall effect size	95%CI of overall effect	P-value
Operative time	10	577	1064	< 0.00001	98%	R	WMD = 74.66	43.71, 105.62	< 0.00001
EBL	9	547	1034	< 0.00001	95%	R	WMD = -280.46	-347.73, -213.19	< 0.00001
Transfusion rate	10	573	1071	0.15	32%	F	OR = 0.45	0.35, 0.58	< 0.00001
Overall morbidity	9	381	607	0.31	15%	F	OR = 0.88	0.65, 1.18	0.38
Major morbidity	15	829	1414	0.49	0	F	OR = 0.75	0.59, 0.96	0.02
POPF	15	617	1003	0.61	0	F	OR = 0.82	0.64, 1.05	0.11
POPF (grade B/C)	17	877	1531	0.89	0	F	OR = 0.86	0.66, 1.11	0.24
DGE	10	523	801	0.93	0	F	OR = 0.93	0.64, 1.34	0.69
DGE (grade B/C)	7	479	994	0.60	0	F	OR = 0.63	0.45, 0.88	0.006
PPH	11	434	737	0.84	0	F	OR = 1.48	0.93, 2.36	0.10
PPH (grade B/C)	7	454	966	0.91	0	F	OR = 1.02	0.65, 1.60	0.95
Bile leak	7	232	232	0.93	0	F	OR = 1.00	0.45, 2.25	0.99
Gastroente-ric anastomosis fistula	3	136	133	0.54	0	F	OR = 0.49	0.09, 2.73	0.42
Wound infection	9	332	697	0.46	0	F	OR = 0.57	0.39, 0.84	0.005
Intra-abdominal abscess	5	175	340	0.23	29%	F	OR = 0.74	0.39, 1.38	0.34
Bowel obstruction	2	73	73	0.33	0	F	OR = 1.00	0.14, 7.31	1.00
Fluid collection	2	77	77	0.96	0	F	OR = 0.63	0.21, 1.89	0.41
Pneumonia	10	463	880	0.99	0	F	OR = 0.79	0.54, 1.15	0.21
Cardiac event	4	239	648	0.48	0	F	OR = 1.11	0.75, 1.62	0.61
Reoperation	12	544	990	0.46	0	F	OR = 0.76	0.48, 1.21	0.25
ICU admission	2	171	283	0.40	0	F	OR = 0.90	0.53, 1.54	0.71
ICU stay	2	65	227	0.62	0	F	WMD = -2.08	-2.88, -1.29	< 0.00001
Diet start time	3	175	284	<0.0001	90%	R	WMD = -1.75	-3.38, -0.12	0.04
LOS	8	332	500	0.004	67%	R	WMD = -3.69	-4.90, -2.48	< 0.00001
Discharge to a new facility	3	218	490	0.60	0	F	OR = 0.50	0.28, 0.87	0.01
30-d readmission	6	340	508	0.77	0	F	OR = 1.04	0.68, 1.59	0.86
90-d readmission	4	136	279	0.70	0	F	OR = 1.07	0.62, 1.84	0.81
30-d mortality	12	527	1271	0.76	0	F	OR = 1.26	0.59, 2.68	0.55
90-d mortality	9	312	661	0.96	0	F	OR = 0.60	0.31, 1.17	0.14
Time to adjuvant chemothe-rapy	1	39	141	NA	NA	F	WMD = -5.50	-12.71, 1.71	0.14
Tumor size	9	430	745	0.0002	73%	R	WMD = -0.36	-0.63, -0.09	0.008
RLNs	10	388	925	< 0.00001	79%	R	WMD = 1.28	0.29, 2.27	0.01
R0 rate	16	605	1535	0.87	0	F	OR = 1.44	1.07, 1.94	0.02
OS of PDAC
1-yr OS	2	65	427	0.49	0	F	OR = 0.65	0.37, 1.13	0.12
2-yr OS	2	65	427	0.74	0	F	OR = 0.54	0.27, 1.07	0.08
3-yr OS	2	65	427	0.37	0	F	OR = 0.98	0.46, 2.10	0.96
4-yr OS	2	65	427	0.82	0	F	OR = 1.04	0.43, 2.52	0.93
5-yr OS	2	65	427	0.27	17%	F	OR = 0.65	0.19, 2.23	0.49
OS of periampullary adenocarcinoma patients
1-yr OS	2	23	234	0.004	88%	R	OR = 0.85	0.01, 107.31	0.95
3-yr OS	2	23	234	0.01	84%	R	OR = 0.90	0.01, 86.00	0.96
5-yr OS	2	23	234	0.26	20%	F	OR = 1.57	0.43, 5.73	0.49

NA: Not applicable; EBL: Estimated blood loss; Major morbidity: Clavien-Dindo classification ≥ III; RLNs: Retrieved lymph nodes; POPF: Postoperative pancreatic fistula; DGE: Delayed gastric emptying; PPH: Postpancreatectomy hemorrhage; LOS: Length of hospital stay; ICU: Intensive care unit; RFS: Recurrence-free survival; OS: Overall survival; PDAC: Pancreatic ductal adenocarcinoma; WMD: Weighted mean difference; OR: Odds ratio; CI: Confidence interval; F: Fixed-effects model; R: Random-effects model; TLPD: Total laparoscopic pancreaticoduodenectomy; OPD: Open pancreaticoduodenectomy.

Citation: Zhang H, Lan X, Peng B, Li B. Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis. World J Gastroenterol 2019; 25(37): 5711-5731
URL: https://www.wjgnet.com/1007-9327/full/v25/i37/5711.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i37.5711