Background: This systematic review and meta-analysis were performed to summarize available evidence comparing totally minimally invasive pancreaticoduodenectomy (TMIPD) versus open pancreaticoduodenectomy (OPD) Materials and Methods: We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for comparative cohort studies published from January 1990 through April 2018 comparing TMIPD versus OPD. Outcomes evaluated were postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postoperative hemorrhage, wound infection, estimated blood loss, transfusion rate, retrieved lymph nodes (RLNs), R0 rate, reoperation rate, length of hospital stay, and mortality. Statistical analysis was performed with Review Manager, version 5.3 (Cochrane Collaboration).
Results: Sixteen comparative studies were included. Meta-analysis showed no significant difference between TMIPD and OPD in rates of POPF (risk ratio [RR] = 0.80; 95% confidence interval [CI]: 0.58-1.11; P = .18), DGE (RR = 0.80; 95% CI: 0.63-1.01; P = .06), postoperative hemorrhage (RR = 1.32; 95% CI: 0.87-2.00; P = .19), or reoperation (RR = 0.68; 95% CI: 0.45-1.05; P = .08). TMIPD resulted in fewer wound infections (RR = 0.49; 95% CI: 0.33-0.74; P = .0006), less blood loss (mean difference [MD] = 371.65 mL; 95% CI: -473.77 to -269.53; P < .00001), and lower transfusion rate (RR = 0.59; 95% CI: 0.48-0.72; P < .00001) than OPD. No significant differences were found in the rate of R0 resection (P = .32), RLNs (P = .09), hospital stay (P = .73), or mortality (P = .67). However, TMIPD had much longer operative times than OPD (MD = 80.78 minutes; 95% CI: 29.25-132.31; P = .002).
Conclusion: TMIPD appears to be as safe and effective as OPD for periampullary disease. These findings need confirmation with large volume well-designed randomized controlled trials.
Keywords: meta-analysis; minimally invasive; pancreaticoduodenectomy.