Laparoscopic vs Open Pancreaticoduodenectomy-an Updated Meta-Analysis of Randomized Control Trials

Oncological survival in pancreatic head ductal carcinoma: hybrid minimally invasive versus open pancreatoduodenectomy - a single centre analysis

BACKGROUND

Surgery remains the only curative treatment option for pancreatic head cancer. Laparoscopic surgical techniques are increasingly used, in line with the development of visceral surgery as a whole. The success of surgery is measured by the oncological outcome. Aim of this study is to evaluate the oncological outcome and survival after laparoscopic assisted resection of the pancreatic head compared to open surgery for ductal adenocarcinoma.

MATERIALS AND METHODS

Data were collected in a prospectively maintained database. Perioperative and oncological outcomes of 182 laparoscopic pancreatic head resections for ductal carcinoma were compared with 585 open pancreatic head resections. The laparoscopic procedures were performed between 2010 and 2022, the open procedures between 2002 and 2022.

RESULTS

Laparoscopic procedure was significantly superior in terms of intraoperative blood loss (575 vs. 600 ml, P =0.021) and operative time (413 vs. 427 min, P =0.033). Tumor size (25 vs. 27 mm, P =0.028), need for portal vein resection ( P =0.009) and blood transfusion ( P =0.004) were significantly greater in the open group ( P =0.009). The resection margin remained negative significantly more often in the laparoscopic group (159 [87%] vs. 449 [77%], P <0.001). There was no difference in postoperative mortality and morbidity. Postoperative survival at 5 years was significantly better in the laparoscopic group (37 vs. 15%, P <0.001).

CONCLUSIONS

In our cohort, patients who underwent hybrid laparoscopic resection of pancreatic head cancer showed a significantly improved oncological outcome. Most of these effects are due to selection bias, which is not captured by the clinical parameters used to date. Our results highlight the need for additional prognostic factors in pancreatic cancer.

Whether T-tube biliary drainage is necessary after pancreaticoduodenectomy: a single-center retrospective study

BACKGROUND

Postoperative complications of pancreaticoduodenectomy (PD) are still a thorny problem. This study aims to verify the preventative impact of T-tube on them.

METHODS

The electronic medical records and follow-up data of patients who received pancreaticoduodenectomy in our center from July 2016 to June 2020 were reviewed. According to whether T tube was placed during the operation, the patients were divided into T-tube group and not-T-tube group. Propensity score matching analysis was performed to minimize selection bias.

RESULTS

A total of 330 patients underwent PD (Not-T-tube group =226, T-tube group=104). Propensity score matching resulted in 222 patients for further analysis (Not-T-tube group =134, T-tube group=88). Patients' demographics were comparable in the matched cohorts. Significantly higher incidences of clinically relevant postoperative pancreatic fistula (CR-POPF) ((14 (10.45%) VS 20 (22.73%)), P=0.013) were observed in the T-tube group. The total incidence of biliary anastomotic stricture (BAS) was 3.15%. The incidence was slightly lower in the T-tube group, but there was no statistically significant differentiation (6 (4.48%) VS 1 (1.14%), P=0.317).

CONCLUSIONS

It is not feasible to prevent postoperative complications with the application of a T-tube in PD.

Comparative Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy in Distal Cholangiocarcinoma: A Systematic Review and Meta-Analysis

Pancreatoduodenectomy, the primary surgical strategy for managing cholangiocarcinoma, is executed via two distinct methodologies, namely minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD). The selection between these surgical options is critical, as it directly influences patient outcomes, encompassing both short-term recovery metrics and long-term survival rates. Despite the clinical significance of these procedures, there exists a notable void in the literature regarding a comprehensive comparison of MIPD and OPD, particularly in assessing their respective efficacies and complications. This lack of detailed comparative analysis has left a gap in evidence-based guidance for clinicians faced with the decision of choosing the most appropriate surgical approach for their patients. The absence of robust data comparing the two techniques underscores the necessity for a meta-analysis that rigorously examines and contrasts the outcomes associated with MIPD and OPD. By drawing upon a wide array of international studies, this research aims to shed light on the advantages and potential drawbacks of each method, thereby providing a more informed basis for surgical decision-making in the treatment of cholangiocarcinoma.

Prevalence of and risk factors for surgical site infections after pancreaticoduodenectomy: a systematic review and meta-analysis

Background

Surgical site infections (SSIs) are one of the most common complications after pancreaticoduodenectomy (PD); however, the global prevalence and risk factors for SSIs after PD remain unknown.

Objectives

To investigate the prevalence of and risk factors for SSIs after PD.

Methods

The PubMed, Embase, Cochrane Library, Web of Science, and Science Direct databases were systematically searched from inception to 1 December 2022. Observational studies reporting adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for SSIs in patients undergoing PD were included. Two independent reviewers in teams performed data extraction, risk of bias assessment, and level of evidence analysis. The pooled results were estimated using a random-effects model. The I 2 statistic and Q χ 2 statistic were used to assess heterogeneity. Funnel plots, Egger's regression test, and the trim-and-fill method were used to determine publication bias. The primary outcomes were identifying risk factors for SSIs after PD. The secondary outcomes were the pooled prevalence rates of SSIs.

Results

A total of 98 704 patients from 45 studies were included, and 80% of the studies were considered high quality. The estimated pooled prevalence of SSIs was 23% (0.19-0.27, I 2=97%). The prevalence of SSIs was found to be higher in Japan and lower in USA. Preoperative biliary stenting, higher body mass index (BMI), longer operation time, postoperative pancreatic fistula, soft pancreatic texture, perioperative blood transfusion, and cardiac disease were identified as significant risk factors for the development of SSIs after PD. Additionally, broad-spectrum antibiotics were a significant protective factor against SSIs. Subgroup analysis and sensitivity analysis showed that the results were robust.

Conclusion and relevance

The prevalence of SSIs remains high and varies widely among regions. It is necessary to take effective preventive measures and carry out more prospective studies to further verify these results.