Laparoscopic versus Open Pancreatoduodenectomy in Patients with Periampullary Tumors: A Systematic Review and Meta-analysis

To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) compared laparoscopic pancreatoduodenectomy (LPD) versus open pancreatoduodenectomy (OPD) in patients with periampullary tumors.LPD has gained attention; however, its safety and efficacy versus OPD remain debatable.We searched PubMed, and Embase. Primary outcomes were the length of hospital stay (LOS) (day), Clavien-Dindo grade≥Ⅲ complications, and 90-day mortality. Secondary outcomes were blood loss (BL) (ml), blood transfusion (BT), duration of operation (minute), readmission, reoperation, comprehensive complication index (CCI) score, bile leak, gastro- or duodenojejunostomy leak, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, surgical site infection (SSI), intraabdominal infection, number of harvested lymph nodes, and R0 resection. Pooled odds ratio (OR) or mean difference (MD) of data were calculated using the random-effect model. The GRADE approach was used for grading the level of evidence.Four RCTs yielding 818 patients were included, of which 411 and 407 patients underwent LPD and OPD, respectively. The meta-analysis concluded that two approaches were similar, except in the LPD group, the LOS tended to be shorter (MD=-2.54 [-5.17, 0.09], P=0.06), LOS in ICU was shorter (MD=-1[-1.8, -0.2], P=0.01), duration of operation was longer (MD=75.16[23.29, 127.03], P=0.005), BL was lower (MD=-115.40[-152.13, -78.68], P0.00001), BT was lower (OR=0.66[0.47, 0.92], P=0.01), and SSI was lower (OR=0.35[0.12, 0.96], P=0.04). The overall certainty of the evidence was moderate.Within the hands of highly skilled surgeons in high-volume centers, LPD is feasible and as safe and efficient as OPD.