Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic outcomes and long-term survival

Ke Chen; Yucheng Zhou; Weiwei Jin; Qicong Zhu; Chao Lu; Nan Niu; Yuanyu Wang; Yiping Mou; Zheling Chen

doi:10.1007/s00464-019-06968-8

Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic outcomes and long-term survival

Surg Endosc. 2020 May;34(5):1948-1958. doi: 10.1007/s00464-019-06968-8. Epub 2019 Jul 17.

Authors

Ke Chen^{1

2}, Yucheng Zhou^{1

2}, Weiwei Jin¹, Qicong Zhu¹, Chao Lu¹, Nan Niu¹, Yuanyu Wang¹, Yiping Mou^{3

4}, Zheling Chen^{5

6}

Affiliations

¹ Department of Gastroenterology & Pancreatic Surgery, Zhejiang Province People's Hospital, No 158 Shangtang Road, Hangzhou, 310000, Zhejiang, People's Republic of China.
² Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, 310014, Zhejiang, People's Republic of China.
³ Department of Gastroenterology & Pancreatic Surgery, Zhejiang Province People's Hospital, No 158 Shangtang Road, Hangzhou, 310000, Zhejiang, People's Republic of China. yippingmou@126.com.
⁴ Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, 310014, Zhejiang, People's Republic of China. yippingmou@126.com.
⁵ Department of Medical Oncology, Zhejiang Province People's Hospital, No.158 Shangtang Road, Hangzhou, 310000, Zhejiang, People's Republic of China. 383974903@qq.com.
⁶ Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, 310014, Zhejiang, People's Republic of China. 383974903@qq.com.

PMID: 31317331
DOI: 10.1007/s00464-019-06968-8

Abstract

Objective: The study aimed to compare the oncologic outcomes and long-term survival of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for patients diagnosed with pancreatic ductal adenocarcinoma (PDAC).

Background: Substantial evidence demonstrated that LPD is technically safe and feasible with perioperative outcomes equivalent to that of OPD. However, for patients with malignancy, especially PDAC, the oncologic outcomes and long-term survival of patients who underwent LPD remains to be elucidated.

Methods: Studies on LPD for the treatment of PDAC published before December 25, 2018 were searched online. The oncologic outcomes (e.g., numbers of lymph nodes retrieved, negative margin (R0) resection), and long-term survival (postoperative survival from 1 to 5 year) of LPD were compared to that of ODP.

Results: After screening 1507 studies, six comparative cohort studies, which reported the oncologic outcomes and long-term survival of patients with PDAC were included. No significant difference was found between LPD and OPD regarding lymph nodes harvested (OR 1.96, 95% CI - 1.17 to 5.09, p = 0.22), R0 rate (OR 1.44, 95% CI 1.00 to 2.06, p = 0.05), number of positive lymph nodes (OR - 0.44, 95% CI - 1.06 to 0.17, p = 0.16), rate of adjuvant treatment (OR 1.04, 95% CI 0.68 to 1.59, p = 0.86) and time to adjuvant treatment (OR - 6.21, 95% CI - 16.00 to 3.59, p = 0.21). LPD showed similar 1-year (OR 1.20, 95% CI 0.87 to 1.65, p = 0.28), and 2-year survival (OR 1.25, 95% CI 0.94 to 1.66, p = 0.13) to that of OPD. The 3-year (OR 1.50, 95% CI 1.12 to 2.02, p = 0.007), 4-year (OR 1.73, 95% CI 1.02 to 2.93, p = 0.04), and 5-year survival (OR 2.11, 95% CI 1.35 to 3.31, p = 0.001) were significantly longer in LPD group.

Conclusion: For the treatment of PDAC, the oncologic outcomes of LPD were equivalent to that of OPD; LPD seemed promising regarding the postoperative long-term survival.

Keywords: Laparoscopic pancreaticoduodenectomy; Long-term survival; Meta-analysis; Oncologic outcomes; Pancreatic cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma / mortality
Adenocarcinoma / surgery*
Carcinoma, Pancreatic Ductal / mortality
Carcinoma, Pancreatic Ductal / surgery*
Female
Humans
Laparoscopy / methods*
Male
Pancreaticoduodenectomy / methods*
Retrospective Studies
Survival Analysis