Menegat Brenda Luana Rocha Soares, Menegat Ana Luíza Rocha Soares, Matheus Gustavo Tadeu Freitas Uchôa, Talah Barbara Antonia Dups, Simões Bárbara Côrrea Garcia, Dantas Clara Rocha, de Moraes Francisco Cezar Aquino
University of Caxias do Sul, Caxias do Sul, Brazil.
Federal University of Triângulo Mineiro, Uberaba, Brazil.
Ann Surg Oncol. 2025 Sep 5. doi: 10.1245/s10434-025-18219-3.
This systematic review and meta-analysis compared the intraoperative and postoperative outcomes of minimally invasive versus open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC), which is a highly aggressive tumor with a high mortality rate. Surgical resection remains the only potentially curative treatment. Minimally invasive distal pancreatectomy (MIDP), including laparoscopic and robotic approaches, has gained popularity, although the evidence of its efficacy is limited.
PubMed, Scopus, and Web of Science databases were searched for studies that compared MIDP and ODP. Randomized clinical trials (RCTs) and observational studies were included. Risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CI) were used to analyze the outcomes. Heterogeneity was assessed using the I test, and statistical significance was set at p < 0.05. Analyses were conducted using the RStudio version 4.4.1.
A total of 20 studies with 9339 patients were included, of which 2219 (23.76%) underwent MIDP and 7120 (76.24%) ODP. MIDP was associated with reduced hospital stay (MD - 1.99; p < 0.000001), infections (RR 0.58; p = 0.001855), delayed gastric emptying (RR 0.48; p = 0.003677), blood loss (MD - 55.55; p = 0.000005), transfusions (RR 0.36; p < 0.000001), and 90-day mortality (RR 0.43; p = 0.001092). Other outcomes, including pancreatic fistula, complications according to the Clavien-Dindo classification, operative time, and reoperation, showed insignificant differences.
MIDP for PDAC offers better clinical outcomes than ODP, including reduced infections and transfusions. Further RCTs are needed to validate these findings and update the guidelines.
本系统评价和荟萃分析比较了微创与开放性远端胰腺切除术（ODP）治疗胰腺导管腺癌（PDAC）患者的术中和术后结局。PDAC是一种侵袭性很强、死亡率很高的肿瘤。手术切除仍然是唯一可能治愈的治疗方法。微创远端胰腺切除术（MIDP），包括腹腔镜和机器人手术方法，已越来越受欢迎，但其疗效证据有限。
检索PubMed、Scopus和Web of Science数据库，查找比较MIDP和ODP的研究。纳入随机临床试验（RCT）和观察性研究。采用风险比（RR）和平均差（MD）及95%置信区间（CI）分析结局。使用I检验评估异质性，设定统计学显著性为p < 0.05。使用RStudio 4.4.1版本进行分析。
共纳入20项研究，9339例患者，其中2219例（23.76%）接受MIDP，7120例（76.24%）接受ODP。MIDP与住院时间缩短（MD -1.99；p < 0.000001）、感染（RR 0.58；p = 0.001855）、胃排空延迟（RR 0.48；p = 0.003677）、失血（MD -55.55；p = 0.000005）、输血（RR 0.36；p < 0.000001）和90天死亡率（RR 0.43；p = 0.001092）相关。其他结局，包括胰瘘、根据Clavien-Dindo分类的并发症、手术时间和再次手术，差异无统计学意义。
PDAC的MIDP比ODP具有更好的临床结局，包括感染和输血减少。需要进一步的RCT来验证这些发现并更新指南。
