Minimally invasive pancreaticoduodenectomy for periampullary disease: a comprehensive review of literature and meta-analysis of outcomes compared with open surgery
| Autor: | Hendi Maher, Xiao-long Liu, Guang-yi Jiang, Yu Pan, Xiujun Cai, Di Wu, Ke Chen |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Ampulla of Vater
medicine.medical_specialty Blood transfusion Robot Common Bile Duct Diseases medicine.medical_treatment Operative Time Blood Loss Surgical Review 030230 surgery Cochrane Library Pancreaticoduodenectomy 03 medical and health sciences Postoperative Complications 0302 clinical medicine Humans Minimally Invasive Surgical Procedures Medicine Blood Transfusion lcsh:RC799-869 Minimally invasive Laparoscopy medicine.diagnostic_test Gastric emptying business.industry Gastroenterology General Medicine Perioperative Length of Stay medicine.disease Surgery Meta-analysis Pancreatic fistula 030220 oncology & carcinogenesis lcsh:Diseases of the digestive system. Gastroenterology Morbidity business Research Article |
| Zdroj: | BMC Gastroenterology BMC Gastroenterology, Vol 17, Iss 1, Pp 1-15 (2017) |
| ISSN: | 1471-230X |
| DOI: | 10.1186/s12876-017-0691-9 |
| Popis: | Background Minimally invasive pancreatoduodenectomy (MIPD) has been gradually attempted. However, whether MIPD is superior, equal or inferior to its conventional open pancreatoduodenectomy (OPD) is not clear. Methods Studies published up to May 2017 were searched in PubMed, Embase, Cochrane Library, and Web of Science. Main outcomes were comprehensively reviewed and measured including conversion to open approach, operation time (OP), estimated blood loss (EBL), transfusion, length of hospital stay (LOS), overall complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), readmission, reoperation and reasons of preoperative death, number of retrieved lymph nodes (RLN), surgical margins, recurrence, and survival. The software of Review Manage version 5.1 was used for meta-analysis. Results One hundred studies were included for systematic review and 26 out of them (totally 3402 cases, 1064 for MIPD, 2338 for OPD) were included for meta-analysis. In the early years, most articles were case reports or non-control case series studies, while in the last 6 years high-volume and comparative researches were increasing gradually. Systematic review revealed conversion rates of MIPD to OPD ranged from 0% to 40%. The mean or median OP of MIPD ranged from 276 to 657 min. The total POPF rates vary between 3.8% and 50% observed in all systematic reviewed studies. Meta-analysis demonstrated MIPD had longer OP (WMD = 99.4 min; 95%CI: 46.0 ~ 152.8, P < 0.01), lower blood loss (WMD = −0.54 ml; 95% CI, −0.88 ~ −0.20 ml; P < 0.01), lower transfusion rate (RR = 0.73, 95%CI: 0.57 ~ 0.94, P = 0.02), shorter LOS (WMD = −3.49 days; 95%CI: -4.83 ~ −2.15, P < 0.01). There was no significant difference in time to oral intake, postoperative complications, POPF, reoperation, readmission, perioperative mortality and number of retrieved lymph nodes. Conclusion Our study demonstrates MIPD is technically feasible and safety on the basis of historical studies. MIPD is associated with less blood loss, faster postoperative recovery, shorter length of hospitalization and longer operation time. These findings are waiting for being confirmed with robust prospective comparative studies and randomized clinical trials. Electronic supplementary material The online version of this article (10.1186/s12876-017-0691-9) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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