Minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma

• Verfasst von: Uijterwijk, Bas [VerfasserIn]
• Verfasst von: Wei, Kongyuan [VerfasserIn]
• Verfasst von: Kasai, Meidai [VerfasserIn]
• Verfasst von: Ielpo, Benedetto [VerfasserIn]
• Verfasst von: Hilst, Jony van [VerfasserIn]
• Verfasst von: Chinnusamy, Palanivelu [VerfasserIn]
• Verfasst von: Lemmers, Daniel H. L. [VerfasserIn]
• Verfasst von: Burdio, Fernando [VerfasserIn]
• Verfasst von: Senthilnathan, Palanisamy [VerfasserIn]
• Verfasst von: Besselink, Marc G. [VerfasserIn]
• Verfasst von: Abu Hilal, Mohammed [VerfasserIn]
• Verfasst von: Qin, Renyi [VerfasserIn]
• Titel: Minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma
• Titelzusatz: Individual patient data meta-analysis of randomized trials
• Verf.angabe: Bas A. Uijterwijk, Kongyuan Wei, Meidai Kasai, Benedetto Ielpo, Jony van Hilst, Palanivelu Chinnusamy, Daniel H. L. Lemmers, Fernando Burdio, Palanisamy Senthilnathan, Marc G. Besselink, Mohammed Abu Hilal, Renyi Qin
• E-Jahr: 2023
• Jahr: 10 August 2023
• Umfang: 11 S.
• Fussnoten: Gesehen am 02.02.2024
• Titel Quelle: Enthalten in: European journal of surgical oncology
• Ort Quelle: Burlington, Mass. : Harcourt, 1995
• Jahr Quelle: 2023
• Band/Heft Quelle: 49(2023), 8, Seite 1351-1361
• ISSN Quelle: 1532-2157
• DOI: doi:10.1016/j.ejso.2023.03.227
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: HPB surgery
• Sach-SW: Minimally invasive pancreatoduodenectomy
• Sach-SW: Minimally invasive surgery
• Sach-SW: Open pancreatoduodenectomy
• Sach-SW: Pancreatic ductal adenocarcinoma
• Sach-SW: Pancreatoduodenectomy
• K10plus-PPN: 1879910934

Abstract

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.