Systematic Review Of Laparoscopic Pancreatoduodenectomy Vs Open Pancreaticoduodenectomy(Meta-Analysis)

Objective: To evaluate the short-term effectiveness and security of laparoscopic pancreaticoduodenectomy(LPD)vs open pancreaticoduodenectomy(OPD)by analyzing perioperative data of the two operation methods and to provide an objective choice for clinical treatment.Methods:The random-effects or non-random-effects model was performed on studies on relative perioperative clinical data of two operation methods published from 2011 to now by screening Pubmed and Embase,The cochrane library data.Perioperative clinical data were collected from 1022 cases operated pancreaticoduodenectomy(PD)by screening 856 references published.Of these,LPD was 379 patients and OPD was 643 patients.The short-term effectiveness and security were compared in the two operation methods.The preoperative data of the two groups included age,gender,body mass index(BMI).The intraoperative data included operative time and intraoperative blood loss.The postoperative data included tumor size,number of lymph node harvested,R0 margin rate,pancreatic fistula rate,bile leakage rate,delayed gastric emptying rate,pulmonary complication,reoperation rate,length of hospital stay and mortality rate.The cochrane network RevMan 5.3was used for meta-analysis.Heterogeneity test was performed by Chi-square test.If the heterogeneity was small(P>0.1,I2<50%),the fixed-effects model was used,if the heterogeneity was large(P<0.1,I2>50%),the random-effects model was used.Continuous variables was analyzed by weighted mean difference(WMD)and dichotomous variables was analyzed by relative risk(RR).The confidence intervals(CI)was 95%.The value of P < 0.05 was considered to indicate statistical significance.Results:Preoperative data: There was no significant difference in age,gender and BMI in the two groups.Intraoperative data: The LPD group hadsignificantly longer operative time[WMD=94.99,95%CI(33.12~156.87),P< 0.05] and less blood loss[WMD=-240.93,95%CI(-431.14~-50.71),P <0.05].Postoperative data of the patients: The LPD group had smaller tumor sizes [WMD=-0.39,95%CI(-0.60~-0.19),P<0.05],higher R0 margin rate[WMD=1.07,95%CI(1.01~1.15),P<0.05],higher postoperation hemorrhage[WMD=1.85,95%CI(1.08~3.17),P<0.05],shorter hospital stay[WMD=-3.68,95%CI(-5.57~-1.79),P<0.05] than OPD group.There were no significant differences between LPD and OPD group in pancreatic fistula[WMD=1.01,95%CI(0.78~1.30),P>0.05],bile leakage rate[WMD=1.22,95%CI(0.54~2.71),P>0.05],delayed gastric emptying rate[WMD=0.86,95 %CI(0.56~1.33),P>0.05],pulmonary complications [WMD=0.86,95%CI(0.43~1.73),P > 0.05],reoperation rate[WMD=0.93,95%CI(0.60 ~ 1.44),P > 0.05],mortality rate[WMD=1.00,95%CI(0.62 ~ 1.61),P > 0.05],and number of lymph node[WMD=1.01,95%CI(-1.77~3.79),P>0.05].Conclusion:Compared to OPD,the advantage of LPD was less blood loss,higher R0 margin rate and shorter hospital stay.But the shortcoming of the LPD was longer operation time,higher post-operative hemorrhage rate and strict selection.It needed to be performed in a high-volume pancreatic surgery center in selected patients.