Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
Int J Surg. 2022 Sep;105:106799. doi: 10.1016/j.ijsu.2022.106799. Epub 2022 Aug 19.
Validity of the laparoscopic approach in pancreatic head lesion remains debatable. This study aims to compare the safety and effectiveness of laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD) and investigate the source of heterogeneity from surgeons' and patients' perspectives.
We searched PubMed, Cochrane, Embase, and Web of Science for studies published before February 1, 2021. Of 6578 articles, 81 were full-text reviewed. The primary outcome was mortality. Three independent reviewers screened and extracted the data and resolved disagreements by consensus. Studies were evaluated for quality using ROB2.0 and ROBINS-I. According to different study designs, sensitivity and meta-regression analyses were conducted to explore the heterogeneity source. This meta-analyses was also conducted to explore the learning curve's heterogeneity. This study was registered with PROSPERO, CRD42021234579.
We analyzed 34 studies involving 46,729 patients (4705 LPD and 42,024 OPD). LPD was associated with lower (P = 0.025) in unmatched studies (P = 0.017). No differences in mortality existed in randomized controlled trials (P = 0.854) and matched studies (P = 0.726). Sensitivity analysis found no significant difference in mortality in elderly patients, patients with pancreatic cancer, and in high- and low-volume hospitals (all P > 0.05). In studies at the early period of LPD (<40 cases), higher mortality (P < 0.001) was found (all P < 0.05).LPD showed non-inferiority in length of stay, complications, and survival outcomes in all analyses.
In high-volume centers with adequate surgical experience, LPD in selected patients appears to be a valid alternative to LPD with comparable mortality, LOS, complications, and survival outcomes.
腹腔镜在胰头部病变中的应用价值仍存在争议。本研究旨在比较腹腔镜胰十二指肠切除术（LPD）和开腹胰十二指肠切除术（OPD）的安全性和有效性，并从外科医生和患者的角度探讨异质性的来源。
我们检索了 PubMed、Cochrane、Embase 和 Web of Science 数据库，检索截至 2021 年 2 月 1 日之前发表的研究。在 6578 篇文章中，有 81 篇进行了全文审查。主要结局指标为死亡率。三名独立的审查员进行了筛选和数据提取，并通过共识解决了分歧。使用 ROB2.0 和 ROBINS-I 评估研究质量。根据不同的研究设计，进行敏感性分析和荟萃回归分析以探讨异质性的来源。还进行了荟萃分析以探讨学习曲线的异质性。本研究在 PROSPERO 注册，CRD42021234579。
我们分析了 34 项研究，共涉及 46729 例患者（4705 例 LPD 和 42024 例 OPD）。在未匹配的研究中，LPD 与较低的死亡率相关（P=0.025）。在随机对照试验（P=0.854）和匹配研究（P=0.726）中，死亡率无差异。敏感性分析发现，在老年患者、胰腺癌患者以及高、低容量医院中，死亡率无显著差异（均 P>0.05）。在 LPD 早期（<40 例）的研究中，死亡率较高（P<0.001）（均 P<0.05）。在所有分析中，LPD 在住院时间、并发症和生存结果方面均表现出非劣效性。
在具有充足手术经验的高容量中心，对于特定患者，LPD 似乎是一种有效的替代方法，其死亡率、住院时间、并发症和生存结果相当。
