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The clinical implication of minimally invasive versus open pancreatoduodenectomy for non-pancreatic periampullary cancer: a systematic review and individual patient data meta-analysis

Background: Most studies on minimally invasive pancreatoduodenectomy (MIPD) combine patients with pancreatic and periampullary cancers even though there is substantial heterogeneity between these tumors. Therefore, this study aimed to evaluate the role of MIPD compared to open pancreatoduodenectomy...

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Hauptverfasser: Uijterwijk, Bas (VerfasserIn) , Kasai, Meidai (VerfasserIn) , Lemmers, Daniel H. L. (VerfasserIn) , Chinnusamy, Palanivelu (VerfasserIn) , van Hilst, Jony (VerfasserIn) , Ielpo, Benedetto (VerfasserIn) , Wei, Kongyuan (VerfasserIn) , Song, Ki Byung (VerfasserIn) , Kim, Song C. (VerfasserIn) , Klompmaker, Sjors (VerfasserIn) , Jang, Jin-Young (VerfasserIn) , Herremans, Kelly M. (VerfasserIn) , Bencini, Lapo (VerfasserIn) , Coratti, Andrea (VerfasserIn) , Mazzola, Michele (VerfasserIn) , Menon, Krishna V. (VerfasserIn) , Goh, Brian K. P. (VerfasserIn) , Qin, Renyi (VerfasserIn) , Besselink, Marc G. (VerfasserIn) , Abu Hilal, Mohammed (VerfasserIn) , Hakeem, Abdul (VerfasserIn) , Burdio, Fernando (VerfasserIn) , Senthilnathan, Palanisamy (VerfasserIn) , Sánchez, Patricia (VerfasserIn) , Kim, Hyeong Seok (VerfasserIn) , Hughes, Steven J. (VerfasserIn) , Giani, Alessandro (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 2023
In: Langenbeck's archives of surgery
Year: 2023, Jahrgang: 408, Pages: 1-15
ISSN:1435-2451
DOI:10.1007/s00423-023-03047-4
Online-Zugang:Verlag, kostenfrei, Volltext: https://doi.org/10.1007/s00423-023-03047-4
Volltext
Verfasserangaben:Bas A. Uijterwijk, Meidai Kasai, Daniel H.L. Lemmers, Palanivelu Chinnusamy, Jony van Hilst, Benedetto Ielpo, Kongyuan Wei, Ki Byung Song, Song C. Kim, Sjors Klompmaker, Jin-Young Jang, Kelly M. Herremans, Lapo Bencini, Andrea Coratti, Michele Mazzola, Krishna V. Menon, Brian K.P. Goh, Renyi Qin, Marc G. Besselink, Mohammed Abu Hilal, Abdul Hakeem, Fernando Burdio, Palanisamy Senthilnathan, Patricia Sánchez, Hyeong Seok Kim, Steven J. Hughes, Alessandro Giani for the International Study Group on non-pancreatic periAmpullary CAncer (ISGACA)
Beschreibung
Zusammenfassung:Background: Most studies on minimally invasive pancreatoduodenectomy (MIPD) combine patients with pancreatic and periampullary cancers even though there is substantial heterogeneity between these tumors. Therefore, this study aimed to evaluate the role of MIPD compared to open pancreatoduodenectomy (OPD) in patients with non-pancreatic periampullary cancer (NPPC). Methods: A systematic review of Pubmed, Embase, and Cochrane databases was performed by two independent reviewers to identify studies comparing MIPD and OPD for NPPC (ampullary, distal cholangio, and duodenal adenocarcinoma) (01/2015–12/2021). Individual patient data were required from all identified studies. Primary outcomes were (90-day) mortality, and major morbidity (Clavien-Dindo 3a-5). Secondary outcomes were postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), blood-loss, length of hospital stay (LOS), and overall survival (OS). Results: Overall, 16 studies with 1949 patients were included, combining 928 patients with ampullary, 526 with distal cholangio, and 461 with duodenal cancer. In total, 902 (46.3%) patients underwent MIPD, and 1047 (53.7%) patients underwent OPD. The rates of 90-day mortality, major morbidity, POPF, DGE, PPH, blood-loss, and length of hospital stay did not differ between MIPD and OPD. Operation time was 67 min longer in the MIPD group (P = 0.009). A decrease in DFS for ampullary (HR 2.27, P = 0.019) and distal cholangio (HR 1.84, P = 0.025) cancer, as well as a decrease in OS for distal cholangio (HR 1.71, P = 0.045) and duodenal cancer (HR 4.59, P < 0.001) was found in the MIPD group. Conclusions: This individual patient data meta-analysis of MIPD versus OPD in patients with NPPC suggests that MIPD is not inferior in terms of short-term morbidity and mortality. Several major limitations in long-term data highlight a research gap that should be studied in prospective maintained international registries or randomized studies for ampullary, distal cholangio, and duodenum cancer separately.
Beschreibung:Online veröffentlicht: 15. August 2023
Gesehen am 14.11.2023
Beschreibung:Online Resource
ISSN:1435-2451
DOI:10.1007/s00423-023-03047-4

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