Laparoscopic Pancreatoduodenectomy (LPD) vs. Open Pancreatoduodenectomy (OPD)

Laparoscopic pancreatoduodenectomy (LPD) is a safe option compared to open pancreatoduodenectomy (OPD) in patients with periampullary tumors, finds a study published in Annals of Surgery Journal.

The systematic review and meta-analysis by Shahab Aldin and colleagues included 4 randomized controlled trials (RCTs) that yielded a total of 818 patients, of which 411 and 407 patients underwent LPD and OPD, respectively.

Findings of the Review

• Shorter length of hospital stay (LOS) for LPD (MD = −2.54 [−5.17, 0.09], P = 0.06)
• Shorter LOS in the ICU for LPD (MD = −1[−1.8, −0.2], P = 0.01)
• Longer duration of operation for LPD (MD = 75.16[23.29, 127.03], P = 0.005)
• Lower blood loss (BL) for LPD (MD = −115.40[−152.13, −78.68], P < 0.00001)
• Lower rate of blood transfusion (BT) for LPD (OR = 0.66[0.47, 0.92], P = 0.01)
• Lower rate of surgical site infection (SSI) for LPD (OR = 0.35[0.12, 0.96], P = 0.04)

However, when it comes to the overall complications (Clavien-Dindo grade ≥ III), 90-day mortality, readmission, reoperation, comprehensive complication index (CCI) score, bile leak, gastro- or duodenojejunostomy leak, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, and intraabdominal infection, there were no significant differences.

This meta-analysis suggests that LPD is a safe and efficient option compared to OPD in patients with periampullary tumors. The study found that LPD tended to result in shorter hospital stays, shorter stays in the ICU, lower blood loss, and lower rates of surgical site infections when compared to OPD. However, the duration of the operation was longer in the LPD group. These findings are supported by moderate levels of evidence. However, it is important to note that the results of this meta-analysis are based on a small number of randomized controlled trials, and thus further studies are needed to confirm these findings and ensure that LPD is as safe and efficient as OPD in a wider population.

Reference

Sattari, S. A., Sattari, A. R., Makary, M. A., Hu, C., & He, J. (2022). Laparoscopic versus open pancreatoduodenectomy in patients with periampullary tumors: A systematic review and meta-analysis. Annals of Surgery, 10.1097/SLA.0000000000005785. https://doi.org/10.1097/SLA.0000000000005785