Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer mortality worldwide. Total laparoscopic pancreaticoduodenectomy (TLPD) have been used in the treatment of benign and low-grade diseases on the pancreatic head. It is necessary to expand the current knowledge on the feasibility and safety of TLPD for PDAC treatment. We aimed to assess the surgical and oncological outcomes of TLPD for patients with PDAC by comparing them with open pancreaticoduodenectomy (OPD). Methods Data regarding patients who underwent pancreaticoduodenectomy for PDAC treatment from January 2013 to January 2019 in our hospital were obtained. Baseline characteristics, intraoperative effects, postoperative recoveries, and survival outcomes were compared. To overcome selection bias, we performed a 1:1 match using propensity score matching (PSM) between TLPD and OPD. We also conducted a systematic review and meta-analysis. Results The original cohort included 276 patients (TLPD; 98 patients, OPD; 178 patients). After PSM, there were 89 patients in each group and the patient demographics were well matched. Of the 98 patients who underwent TLPD, 8 (8.2%) required conversions to laparotomies. Compared to OPD, TLPD could be performed with longer operative times, had less blood loss, and had lower overall morbidities. Regarding oncological and survival outcomes, there were no significant differences in tumor size, R0 resection rates and tumor stages between groups. However, TLPD had an advantage over OPD in terms of retrieved lymph nodes (21.9 ± 6.6 vs. 18.9 ± 5.4, p < 0.01). There were no statistically significant differences between the groups in recurrence patterns, and the 3-year recurrence-free and overall survival rates were comparable between the two groups. Meta-analysis further confirmed that the TLPD were associated with longer operative times, less blood loss, shorter hospitalizations, lower morbidities, and a greater number of retrieved lymph nodes. Conclusions TLPD are feasible and oncologically safe procedures for PDAC treatments. Postoperative outcomes and long-term survival after TLPD are superior, or not inferior, to OPD, and could be a promising alternative to open surgery for PDAC treatments. Our findings should be further evaluated by multicenter or randomized controlled trials.
Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis
