Chen Ke, Liu Xiao-Long, Pan Yu, Maher Hendi, Wang Xian-Fa
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.
BMC Gastroenterol. 2018 Jul 3;18(1):102. doi: 10.1186/s12876-018-0830-y.
Laparoscopic pancreaticoduodenectomy (LPD) remains to be established as a safe and effective alternative to open pancreaticoduodenectomy (OPD) for pancreatic-head and periampullary malignancy. The purpose of this meta-analysis was to compare LPD with OPD for these malignancies regarding short-term surgical and long-term survival outcomes.
A literature search was conducted before March 2018 to identify comparative studies in regard to outcomes of both LPD and OPD for the treatment of pancreatic-head and periampullary malignancies. Morbidity, postoperative pancreatic fistula (POPF), mortality, operative time, estimated blood loss, hospitalization, retrieved lymph nodes, and survival outcomes were compared.
Among eleven identified studies, 1196 underwent LPD, and 8247 were operated through OPD. The pooled data showed that LPD was associated with less morbidity (OR = 0.57, 95%CI: 0.41~ 0.78, P < 0.01), less blood loss (WMD = - 372.96 ml, 95% CI, - 507.83~ - 238.09 ml, P < 0.01), shorter hospital stays (WMD = - 197.49 ml, 95% CI, - 304.62~ - 90.37 ml, P < 0.01), and comparable POPF (OR = 0.85, 95%CI: 0.59~ 1.24, P = 0.40), and overall survival (HR = 1.03, 95%CI: 0.93~ 1.14, P = 0.54) compared to OPD. Operative time was longer in LPD (WMD = 87.68 min; 95%CI: 27.05~ 148.32, P < 0.01), whereas R0 rate tended to be higher in LPD (OR = 1.17; 95%CI: 1.00~ 1.37, P = 0.05) and there tended to be more retrieved lymph nodes in LPD (WMD = 1.15, 95%CI: -0.16~ 2.47, P = 0.08), but these differences failed to reach statistical significance.
LPD can be performed as safe and effective as OPD for pancreatic-head and periampullary malignancy with respect to both surgical and oncological outcomes. LPD is associated with less intraoperative blood loss and postoperative morbidity and may serve as a promising alternative to OPD in selected individuals in the future.
对于胰头和壶腹周围恶性肿瘤，腹腔镜胰十二指肠切除术（LPD）作为开放胰十二指肠切除术（OPD）安全有效的替代方案，仍有待确立。本荟萃分析的目的是比较LPD和OPD治疗这些恶性肿瘤的短期手术和长期生存结局。
在2018年3月之前进行文献检索，以确定关于LPD和OPD治疗胰头和壶腹周围恶性肿瘤结局的比较研究。比较了发病率、术后胰瘘（POPF）、死亡率、手术时间、估计失血量、住院时间、获取的淋巴结数量和生存结局。
在11项纳入研究中，1196例行LPD，8247例行OPD。汇总数据显示，与OPD相比，LPD的发病率较低（OR = 0.57，95%CI：0.410.78，P < 0.01），失血量较少（WMD = -372.96 ml，95%CI，-507.83-238.09 ml，P < 0.01），住院时间较短（WMD = -197.49 ml，95%CI，-304.62-90.37 ml，P < 0.01），POPF相当（OR = 0.85，95%CI：0.591.24，P = 0.40），总生存情况相当（HR = 1.03，95%CI：0.931.14，P = 0.54）。LPD的手术时间较长（WMD = 87.68分钟；95%CI：27.05148.32，P < 0.01），而LPD的R0切除率有更高的趋势（OR = 1.17；95%CI：1.001.37，P = 0.05），且LPD获取的淋巴结数量有更多的趋势（WMD = 1.15，95%CI：-0.162.47，P = 0.08），但这些差异未达到统计学意义。
就手术和肿瘤学结局而言，LPD治疗胰头和壶腹周围恶性肿瘤的安全性和有效性与OPD相当。LPD术中失血量和术后发病率较低，未来可能成为特定患者OPD的有前景的替代方案。
