Laparoscopic Pancreaticoduodenectomy Versus Conventional Open Approach for Patients With Pancreatic Duct Adenocarcinoma: An Up-to-Date Systematic Review and Meta-Analysis

BackgroundTo compare perioperative and oncological outcomes of pancreatic duct adenocarcinoma (PDAC) after laparoscopic versus open pancreaticoduodenectomy (LPD vs. OPD), we performed a meta-analysis of currently available propensity score matching studies and large-scale retrospective cohorts to compare the safety and overall effect of LPD to OPD for patients with PDAC.MethodsA meta-analysis was registered at PROSPERO and the registration number is CRD42021250395. PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Data on operative times, blood loss, 30-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien–Dindo ≥3 complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, overall survival, and long-term survival) were subjected to meta-analysis.ResultsOverall, we identified 10 retrospective studies enrolling a total of 11,535 patients (1,514 and 10,021 patients underwent LPD and OPD, respectively). The present meta-analysis showed that there were no significant differences in overall survival time, 1-year survival, 2-year survival, 30-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, and lymph node dissection between the LPD and OPD groups. Nevertheless, compared with the OPD group, LPD resulted in significantly higher rate of R0 resection (OR: 1.22; 95% CI 1.06–1.40; p = 0.005), longer operative time (WMD: 60.01 min; 95% CI 23.23–96.79; p = 0.001), lower Clavien–Dindo grade ≥III rate (p = 0.02), less blood loss (WMD: −96.49 ml; 95% CI −165.14 to −27.83; p = 0.006), lower overall morbidity rate (OR: 0.65; 95% CI 0.50 to 0.85; p = 0.002), shorter LOS (MD = −2.73; 95% CI −4.44 to −1.03; p = 0.002), higher 4-year survival time (p = 0.04), 5-year survival time (p = 0.001), and earlier time to starting adjuvant chemotherapy after surgery (OR: −10.86; 95% CI −19.42 to −2.30; p = 0.01).ConclusionsLPD is a safe and feasible alternative to OPD for patients with PDAC, and compared with OPD, LPD seemed to provide a similar OS.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Download Full-text

Laparoscopic vs. Open Pancreaticoduodenectomy After Learning Curve: A Systematic Review and Meta-Analysis of Single-Center Studies

Frontiers in Surgery ◽

10.3389/fsurg.2021.715083 ◽

2021 ◽

Vol 8 ◽

Author(s):

Qingbo Feng ◽

Zechang Xin ◽

Jie Qiu ◽

Mei Xu

Keyword(s):

Lymph Node ◽

Blood Transfusion ◽

Blood Loss ◽

Learning Curve ◽

Tumor Size ◽

Meta Analysis ◽

Positive Lymph Node ◽

R0 Resection ◽

Node Dissection ◽

Open Pancreaticoduodenectomy

Background: Although laparoscopic pancreaticoduodenectomy (LPD) is a safe and feasible treatment compared with open pancreaticoduodenectomy (OPD), surgeons need a relatively long training time to become technically proficient in this complex procedure. In addition, the incidence of complications and mortality of LPD will be significantly higher than that of OPD in the initial stage. This meta-analysis aimed to compare the safety and overall effect of LPD to OPD after learning curve based on eligible large-scale retrospective cohorts and randomized controlled trials (RCTs), especially the difference in the perioperative and short-term oncological outcomes.Methods: PubMed, Web of Science, EMBASE, Cochrane Central Register, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Only clinical studies reporting more than 40 cases for LPD were included. Data on operative times, blood loss, and 90-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien–Dindo ≥III complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, positive lymph node numbers, and tumor size) were subjected to meta-analysis.Results: Overall, the final analysis included 13 retrospective cohorts and one RCT comprising 2,702 patients (LPD: 1,040, OPD: 1,662). It seems that LPD has longer operative time (weighted mean difference (WMD): 74.07; 95% CI: 39.87–108.26; p < 0.0001). However, compared with OPD, LPD was associated with a higher R0 resection rate (odds ratio (OR): 1.43; 95% CI: 1.10–1.85; p = 0.008), lower rate of wound infection (OR: 0.35; 95% CI: 0.22–0.56; p < 0.0001), less blood loss (WMD: −197.54 ml; 95% CI −251.39 to −143.70; p < 0.00001), lower blood transfusion rate (OR: 0.58; 95% CI 0.43–0.78; p = 0.0004), and shorter LOS (WMD: −2.30 day; 95% CI −3.27 to −1.32; p < 0.00001). No significant differences were found in 90-day mortality, overall morbidity, Clavien–Dindo ≥ III complications, reoperation, POPF, DGE, PPH, lymph node dissection, positive lymph node numbers, and tumor size between LPD and OPD.Conclusion: Comparative studies indicate that after the learning curve, LPD is a safe and feasible alternative to OPD. In addition, LPD provides less blood loss, blood transfusion, wound infection, and shorter hospital stays when compared with OPD.

Download Full-text

Does lateral lymph node dissection for low rectal cancer improve overall survival? Protocol for a systematic review and meta-analysis

International Journal of Surgery Protocols ◽

10.1016/j.isjp.2019.09.001 ◽

2019 ◽

Vol 17 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Jeremy Meyer ◽

Niki Christou ◽

Christophe Combescure ◽

Nicolas Buchs ◽

Frédéric Ris

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Overall Survival ◽

Lymph Node ◽

Lymph Node Dissection ◽

Meta Analysis ◽

Low Rectal Cancer ◽

Lateral Lymph Node Dissection ◽

Node Dissection ◽

Lateral Lymph Node

Download Full-text

Robotic Versus Laparoscopic Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.752236 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qingbo Feng ◽

Chuang Jiang ◽

Xuping Feng ◽

Yan Du ◽

Wenwei Liao ◽

...

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Pancreatic Ductal Adenocarcinoma ◽

Distal Pancreatectomy ◽

Lymph Node Dissection ◽

Meta Analysis ◽

Laparoscopic Distal Pancreatectomy ◽

Ductal Adenocarcinoma ◽

R0 Resection ◽

Node Dissection

BackgroundRobotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) are the two principal minimally invasive surgical approaches for patients with pancreatic body and tail adenocarcinoma. The use of RDP and LDP for pancreatic ductal adenocarcinoma (PDAC) remains controversial, and which one can provide a better R0 rate is not clear.MethodsA comprehensive search for studies that compared robotic versus laparoscopic distal pancreatectomy for PDAC published until July 31, 2021, was conducted. Data on perioperative outcomes and oncologic outcomes (R0-resection and lymph node dissection) were subjected to meta-analysis. PubMed, Cochrane Central Register, Web of Science, and EMBASE were searched based on a defined search strategy to identify eligible studies before July 2021.ResultsSix retrospective studies comprising 572 patients (152 and 420 patients underwent RDP and LDP) were included. The present meta-analysis showed that there were no significant differences in operative time, tumor size, and lymph node dissection between RDP and LDP group. Nevertheless, compared with the LDP group, RDP results seem to demonstrate a possibility in higher R0 resection rate (p<0.0001).ConclusionsThis systematic review and meta-analysis suggest that RDP is a technically and oncologically safe and feasible approach for selected PDAC patients. Large randomized and controlled prospective studies are needed to confirm this data.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier [CRD42021269353].

Download Full-text

Robotic-Assisted Video-Endoscopic Inguinal Lymphadenectomy (RAVEIL) and Video-Endoscopic Inguinal Lymphadenectomy (VEIL) versus Open Inguinal Lymph-Node Dissection (OILND) in carcinoma of penis: Comparison of perioperative outcomes, complications and oncological outcomes. A systematic review and meta-analysis

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.11.010 ◽

2021 ◽

Author(s):

Keval N. Patel ◽

Abhijeet Salunke ◽

Ganesh Bakshi ◽

Dipin Jayaprakash ◽

Shashank J. Pandya

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Inguinal Lymph Node ◽

Meta Analysis ◽

Perioperative Outcomes ◽

Node Dissection ◽

Inguinal Lymph Node Dissection ◽

Robotic Assisted ◽

Oncological Outcomes ◽

Inguinal Lymphadenectomy

Download Full-text

Role of lateral pelvic lymph node dissection in rectal cancer: A systematic review and meta-analysis

Indian Journal of Colo-Rectal Surgery ◽

10.4103/ijcs.ijcs_30_20 ◽

2020 ◽

Vol 3 (2) ◽

pp. 41

Author(s):

Ashwin Rajendiran ◽

Sachin Shenoy ◽

Ahmed Shalaby ◽

YKS Viswanath ◽

Venkatesh Shanmugam

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Meta Analysis ◽

Pelvic Lymph Node Dissection ◽

Pelvic Lymph Node ◽

Node Dissection ◽

Lateral Pelvic Lymph Node

Download Full-text

Survival Benefits Based on the Number of Lymph Nodes Removed during Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9061933 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1933 ◽

Cited By ~ 1

Author(s):

Min Soo Choo ◽

Sangjun Yoo ◽

Hyeong Dong Yuk ◽

Chang Wook Jeong ◽

Min Chul Cho ◽

...

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Lymph Node ◽

Urothelial Carcinoma ◽

Meta Analysis ◽

Upper Tract Urothelial Carcinoma ◽

Radical Nephroureterectomy ◽

Case Control Studies ◽

Level Of Evidence ◽

Upper Tract

The role of lymph node dissection (LND) is still controversial for upper tract urothelial carcinoma (UTUC), and there are no guidelines regarding its use. This study was conducted to find a higher level of evidence for the survival benefits based on the number of LNs removed during radical nephroureterectomy (RNUx) through a systematic review and meta-analysis. We included studies comparing patients who underwent LND during RNUx for UTUC. We searched the major electronic databases (Pubmed, Embase®, and Scopus®) and conducted manual searches of the electronically available abstracts of the major international urology cancer meetings [American Society of Clinical Oncology (ASCO), American Urological Association (AUA), and Eropean Association of Urology (EAU)] prior to April 2019 using grouped terms of nephroureterectomy (nephroureterectom*) and lymph node excision (lymphadenectomy; lymph + node*; lymph* + metasta*) with variations in the terms. Study selection, data collection, and risk of bias assessment were performed by two independent authors (A and B). Six retrospective case-control studies included a total of 33,944 patients who underwent RNUx for UTUC, 5071 of whom underwent LND and were finally included in the meta-analysis. The pooled hazard ratio (HR) in these studies revealed that an increased number of LNs removed during RNUx was associated with improved cancer-specific survival (CSS) in patients with UTUC (HR = 0.95, 95% CI: 0.91–0.99; p = 0.07). In addition, increased numbers of LNs removed were associated with improved overall survival (OS) in pN0 patients. However, in pN+ patients, the number of LNs removed showed no survival benefit on CSS, overall survival (OS), or progression-free survival (PFS). Higher numbers of LNs removed during RNUx were associated with improved survival outcomes in patients with UTUC. This study confirmed that LND also has oncological benefits in UTUC patients. Although still a controversial topic, meticulous LND must be considered, and efforts should be made to eliminate as many LNs as possible when administering RNUx for UTUC, especially in patients without clear evidence of LN metastasis.

Download Full-text