Postoperative Pancreatic Fistula: Is Minimally Invasive Surgery Better than Open? A Systematic Review and Meta-analysis

Anticancer Res. 2022 Jul;42(7):3285-3298. doi: 10.21873/anticanres.15817.

Abstract

Background/aim: Minimally invasive pancreaticoduodenectomy (PD) is gaining popularity. The aim of this study was to compare the incidence of postoperative pancreatic fistula (POPF) after minimally invasive versus open procedures.

Materials and methods: Following the PRISMA statement, literature research was conducted focusing on papers comparing the incidence of POPF after open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD).

Results: Twenty-one papers were included in this meta-analysis, for a total of 4,448 patients. A total of 2,456 patients (55.2%) underwent OPD, while 1,992 (44.8%) underwent MIPD. Age, ASA score III patients, incidence of pancreatic ductal adenocarcinoma and duct diameter were significantly lower in the MIPD group. No statistically significant differences were found between the OPD and MIPD regarding the incidence of major complications (15.6% vs. 17.0%, respectively, p=0.55), mortality (3.7% vs. 2.4%, p=0.81), and POPF rate (14.3% vs. 12.9%, p=0.25).

Conclusion: MIPD and OPD had comparable rates of postoperative complications, postoperative mortality, and POPF.

Keywords: Pancreaticoduodenectomy; duodenopancreatectomy; pancreatic cancer; pancreatic fistula; pancreatic neoplasms; review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / methods
  • Pancreas / surgery
  • Pancreatic Fistula* / epidemiology
  • Pancreatic Fistula* / etiology
  • Pancreaticoduodenectomy* / adverse effects
  • Pancreaticoduodenectomy* / methods
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology