Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China; School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang Province, China.
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
Int J Surg. 2018 May;53:243-256. doi: 10.1016/j.ijsu.2017.12.032. Epub 2018 Jan 11.
Laparoscopic pancreatic surgery (LPS) has been widely used in the treatment of benign and low-grade pancreatic diseases. It is necessary to expand the current knowledge on the feasibility and safety of LPS for pancreatic ductal adenocarcinoma (PDAC) by systematic reviewing the published studies and analyzing them by meta-analysis.
Original articles compared LPS with open pancreatic surgery (OPS) for PDAC, published from January 1994 to August 2017 were searched in medical databases. Postoperative pancreatic fistula (POPF), morbidity, mortality, operation time, blood loss, transfusion, hospital stay, retrieved lymph nodes (RLNs), and survival outcomes were compared.
Fourteen studies with a total of 13174 patients (1705 in LPS and 11469 in OPS) were included for the meta-analysis. LPS showed less morbidity (RR = 0.78, 95%CI: 0.66-0.92, P < .01), blood loss (WMD = -298.05 ml, 95% CI, -482.98∼-113.12 ml; P < .01), shorter hospital stay (WMD = -2.86, 95%CI, -3.85∼-1.87; P < .01), more RLNs (WMD = 1.47, 95%CI: 0.15-2.78; P = .03) and comparable POPF (RR = 1.12, 95%CI: 0.82-1.53, P = .50), operation time (WMD = 22.23 min; 95%CI: -19.56-64.01, P = .30), and 5-year overall survival (HR = 0.92, 95%CI: 0.80-1.06; P = .23) compared to OPS.
LPS can be performed safely in carefully selected patients with PADC and would improve the surgical outcomes. Considering the limitation of study design, the conclusions should be interpret cautiously and warrant to be confirmed by randomized controlled studies.
腹腔镜胰腺手术（LPS）已广泛应用于治疗良性和低级别胰腺疾病。通过系统回顾已发表的研究并进行荟萃分析，有必要扩大目前对 LPS 治疗胰腺导管腺癌（PDAC）的可行性和安全性的认识。
检索了从 1994 年 1 月至 2017 年 8 月发表的比较 LPS 与开腹胰腺手术（OPS）治疗 PDAC 的原始文章，纳入的研究进行荟萃分析。比较术后胰瘘（POPF）、发病率、死亡率、手术时间、出血量、输血、住院时间、检出的淋巴结（RLNs）和生存结局。
纳入 14 项研究，共 13174 例患者（LPS 组 1705 例，OPS 组 11469 例）进行荟萃分析。LPS 显示发病率较低（RR=0.78，95%CI：0.66-0.92，P<.01）、出血量较少（WMD=-298.05ml，95%CI：-482.98∼-113.12ml；P<.01）、住院时间较短（WMD=-2.86，95%CI：-3.85∼-1.87；P<.01）、检出的 RLNs 更多（WMD=1.47，95%CI：0.15-2.78；P=.03），POPF 相似（RR=1.12，95%CI：0.82-1.53，P=.50）、手术时间（WMD=22.23min；95%CI：-19.56-64.01，P=.30）和 5 年总生存率（HR=0.92，95%CI：0.80-1.06；P=.23）与 OPS 相比。
在仔细选择的 PDAC 患者中，LPS 可以安全实施，并改善手术结局。考虑到研究设计的局限性，结论应谨慎解释，并需要随机对照研究的证实。
