腹腔镜胰十二指肠切除术与传统开放手术治疗胰腺导管腺癌患者的比较：最新系统评价与Meta分析
Laparoscopic Pancreaticoduodenectomy Conventional Open Approach for Patients With Pancreatic Duct Adenocarcinoma: An Up-to-Date Systematic Review and Meta-Analysis.
作者信息
Feng Qingbo, Liao Wenwei, Xin Zechang, Jin Hongyu, Du Jinpeng, Cai Yunshi, Liao Mingheng, Yuan Kefei, Zeng Yong
机构信息
Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatobiliary and Pancreatic Surgery Unit I, Peking University Cancer Hospital & Institute, Beijing, China.
出版信息
Front Oncol. 2021 Oct 27;11:749140. doi: 10.3389/fonc.2021.749140. eCollection 2021.
BACKGROUND
To compare perioperative and oncological outcomes of pancreatic duct adenocarcinoma (PDAC) after laparoscopic open pancreaticoduodenectomy (LPD OPD), we performed a meta-analysis of currently available propensity score matching studies and large-scale retrospective cohorts to compare the safety and overall effect of LPD to OPD for patients with PDAC.
METHODS
A meta-analysis was registered at PROSPERO and the registration number is CRD42021250395. PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Data on operative times, blood loss, 30-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien-Dindo ≥3 complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, overall survival, and long-term survival) were subjected to meta-analysis.
RESULTS
Overall, we identified 10 retrospective studies enrolling a total of 11,535 patients (1,514 and 10,021 patients underwent LPD and OPD, respectively). The present meta-analysis showed that there were no significant differences in overall survival time, 1-year survival, 2-year survival, 30-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, and lymph node dissection between the LPD and OPD groups. Nevertheless, compared with the OPD group, LPD resulted in significantly higher rate of R0 resection (OR: 1.22; 95% CI 1.06-1.40; = 0.005), longer operative time (WMD: 60.01 min; 95% CI 23.23-96.79; = 0.001), lower Clavien-Dindo grade ≥III rate ( = 0.02), less blood loss (WMD: -96.49 ml; 95% CI -165.14 to -27.83; = 0.006), lower overall morbidity rate (OR: 0.65; 95% CI 0.50 to 0.85; = 0.002), shorter LOS (MD = -2.73; 95% CI -4.44 to -1.03; = 0.002), higher 4-year survival time ( = 0.04), 5-year survival time ( = 0.001), and earlier time to starting adjuvant chemotherapy after surgery (OR: -10.86; 95% CI -19.42 to -2.30; = 0.01).
CONCLUSIONS
LPD is a safe and feasible alternative to OPD for patients with PDAC, and compared with OPD, LPD seemed to provide a similar OS.
SYSTEMATIC REVIEW REGISTRATION
背景
为比较腹腔镜与开放胰十二指肠切除术（LPD与OPD）治疗胰腺导管腺癌（PDAC）的围手术期及肿瘤学结局，我们对现有的倾向评分匹配研究和大规模回顾性队列进行了荟萃分析，以比较LPD与OPD治疗PDAC患者的安全性和总体效果。
方法
一项荟萃分析已在PROSPERO注册，注册号为CRD42021250395。根据既定的检索策略，检索了PubMed、Web of Science、EMBASE、Cochrane对照试验中央注册库和ClinicalTrials.gov数据库，以识别2021年3月之前的符合条件的研究。对手术时间、失血量、30天死亡率、再次手术、住院时间（LOS）、总体并发症、Clavien-Dindo≥3级并发症、术后胰瘘（POPF）、输血、胃排空延迟（DGE）、胰十二指肠切除术后出血（PPH）和肿瘤学结局（R0切除、淋巴结清扫、总生存期和长期生存期）的数据进行荟萃分析。
结果
总体而言，我们确定了10项回顾性研究，共纳入11535例患者（分别有1514例和10021例患者接受了LPD和OPD）。本荟萃分析表明，LPD组和OPD组在总生存时间、1年生存率、2年生存率、30天死亡率、Clavien-Dindo≥3级并发症、POPF、DGE、PPH和淋巴结清扫方面无显著差异。然而，与OPD组相比，LPD的R0切除率显著更高（OR：1.22；95%CI 1.06-1.40；P = 0.005），手术时间更长（WMD：60.01分钟；95%CI 23.23-96.79；P = 0.001），Clavien-Dindo≥III级发生率更低（P = 0.02），失血量更少（WMD：-96.49毫升；95%CI -165.14至-27.83；P = 0.006），总体并发症发生率更低（OR：0.65；95%CI 0.50至0.85；P = 0.002），LOS更短（MD = -2.73；95%CI -4.44至-1.03；P = 0.002），4年生存时间更长（P = 0.04），5年生存时间更长（P = 0.001），术后开始辅助化疗的时间更早（OR：-10.86；95%CI -19.42至-2.30；P = 0.01）。
结论
对于PDAC患者，LPD是OPD的一种安全可行的替代方案，与OPD相比，LPD似乎能提供相似的总生存期。
系统评价注册
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