Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland.
Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
BJS Open. 2023 Mar 7;7(2). doi: 10.1093/bjsopen/zrad007.
Widespread implementation of the minimally invasive technique in pancreatic surgery has proven to be challenging. The aim of this study was to compare the perioperative outcomes of minimally invasive (laparoscopic and robotic) pancreatic surgery with open pancreatic surgery using data obtained from RCTs.
A literature search was done using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Web of Science; all available RCTs comparing minimally invasive pancreatic surgery and open pancreatic surgery in adults requiring elective distal pancreatectomy or partial pancreatoduodenectomy were included. Outcomes were mortality rate, general and pancreatic surgery specific morbidity rate, and length of hospital stay.
Six RCTs with 984 patients were included; 99.0 per cent (486) of minimally invasive procedures were performed laparoscopically and 1.0 per cent (five) robotically. In minimally invasive pancreatic surgery, length of hospital stay (-1.3 days, -2 to -0.5, P = 0.001) and intraoperative blood loss (-137 ml, -182 to -92, P < 0.001) were reduced. In the subgroup analysis, reduction in length of hospital stay was only present for minimally invasive distal pancreatectomy (-2 days, -2.3 to -1.7, P < 0.001). A minimally invasive approach showed reductions in surgical site infections (OR 0.4, 0.1 to 0.96, P = 0.040) and intraoperative blood loss (-131 ml, -173 to -89, P < 0.001) with a 75 min longer duration of surgery (42 to 108 min, P < 0.001) only in partial pancreatoduodenectomy. No significant differences were found with regards to mortality rate and postoperative complications.
This meta-analysis presents level 1 evidence of reduced length of hospital stay and intraoperative blood loss in minimally invasive pancreatic surgery compared with open pancreatic surgery. Morbidity rate and mortality rate were comparable, but longer duration of surgery in minimally invasive partial pancreatoduodenectomy hints that this technique in partial pancreatoduodenectomy is technically more challenging than in distal pancreatectomy.
微创技术在胰腺外科中的广泛应用已被证明具有挑战性。本研究旨在使用随机对照试验（RCT）的数据比较微创（腹腔镜和机器人）胰腺手术与开腹胰腺手术的围手术期结果。
使用 Cochrane 中央对照试验注册库（CENTRAL）、MEDLINE 和 Web of Science 进行文献检索；纳入所有比较成人选择性胰尾部切除术或胰十二指肠部分切除术的微创胰腺手术与开腹胰腺手术的 RCT。结局指标包括死亡率、普外科和胰腺外科特定并发症发生率以及住院时间。
纳入了 6 项 RCT 共 984 例患者；99.0%（486 例）的微创手术为腹腔镜手术，1.0%（5 例）为机器人手术。在微创胰腺手术中，住院时间（-1.3 天，-2 至-0.5，P=0.001）和术中出血量（-137 ml，-182 至-92，P<0.001）减少。在亚组分析中，仅在微创胰尾部切除术时，住院时间的缩短才有意义（-2 天，-2.3 至-1.7，P<0.001）。微创方法可减少手术部位感染（OR 0.4，0.1 至 0.96，P=0.040）和术中出血量（-131 ml，-173 至-89，P<0.001），但手术时间延长 75 分钟（42 至 108 分钟，P<0.001），仅在胰十二指肠部分切除术时如此。在死亡率和术后并发症方面未发现显著差异。
本荟萃分析提供了 1 级证据，表明与开腹胰腺手术相比，微创胰腺手术可缩短住院时间和减少术中出血量。并发症发生率和死亡率相当，但微创胰十二指肠部分切除术的手术时间较长提示该技术在胰十二指肠部分切除术中比在胰尾部切除术更具挑战性。
