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Oncological outcomes in minimally invasive vs. open distal pancreatectomy: a systematic review and network
Nicky Zhun Hong Wong1, Dominic Wei Ting Yap1, Sherryl Lei Ng1
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Background:
Advancements in surgical techniques have improved outcomes in patients undergoing pancreatic surgery. To date there have been no meta-analyses comparing robotic and laparoscopic approaches for distal pancreatectomies (DP) in patients with pancreatic adenocarcinoma (PDAC). This systematic review and network meta-analysis aims to explore the oncological outcomes of laparoscopic distal pancreatectomy (LDP), robotic distal pancreatectomy (RDP) and open distal pancreatectomy (ODP).
Methods:
A systematic search was conducted for studies reporting laparoscopic, robotic or open surgery for DP. Frequentist network meta-analysis of oncological outcomes (overall survival, resection margins, tumor recurrence, examined lymph nodes, administration of adjuvant therapy) were performed.
Results:
Fifteen studies totalling 9,301 patients were included in the network meta-analysis. 1,946, 605 and 6,750 patients underwent LDP, RDP and ODP respectively. LDP (HR: 0.761, 95% CI: 0.642-0.901, p = 0.002) and RDP (HR: 0.757, 95% CI: 0.617-0.928, p = 0.008) were associated with overall survival (OS) benefit when compared to ODP. LDP (HR: 1.00, 95% CI: 0.793-1.27, p = 0.968) was not associated with OS benefit when compared to RDP. There were no significant differences between LDP, RDP and ODP for resection margins, tumor recurrence, examined lymph nodes and administration of adjuvant therapy.
Conclusion:
This study highlights the longer OS in both LDP and RDP when compared to ODP for patients with PDAC.
Systematic Review Registration:
https://www.crd.york.ac.uk/, PROSPERO (CRD42022336417).
Insights
Robotic and laparoscopic distal pancreatectomies (DP) improve overall survival for pancreatic cancer patients compared to open surgery. Both minimally invasive approaches showed similar survival benefits, with no significant differences in other oncological outcomes.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Pancreatic adenocarcinoma (PDAC) treatment involves complex surgical procedures.
- Distal pancreatectomy (DP) is a key surgical intervention for PDAC.
- Comparative oncological outcomes of robotic, laparoscopic, and open DP are not well-established through meta-analysis.
Purpose of the Study:
- To conduct a systematic review and network meta-analysis comparing oncological outcomes of laparoscopic distal pancreatectomy (LDP), robotic distal pancreatectomy (RDP), and open distal pancreatectomy (ODP).
- To evaluate overall survival, resection margins, tumor recurrence, lymph node examination, and adjuvant therapy administration across the three surgical approaches for PDAC.
Main Methods:
- Systematic literature search for studies reporting LDP, RDP, or ODP for DP.
- Frequentist network meta-analysis of oncological outcomes.
- Inclusion of 15 studies with a total of 9,301 patients.
Main Results:
- Both LDP (HR: 0.761) and RDP (HR: 0.757) were associated with improved overall survival (OS) compared to ODP (p < 0.008).
- No significant OS difference was found between LDP and RDP (p = 0.968).
- No significant differences were observed among LDP, RDP, and ODP for resection margins, tumor recurrence, examined lymph nodes, or adjuvant therapy.
Conclusions:
- Laparoscopic and robotic distal pancreatectomies offer a significant overall survival benefit over open distal pancreatectomy for patients with pancreatic adenocarcinoma.
- The oncological safety and efficacy of LDP and RDP are comparable.
- Minimally invasive approaches should be considered for distal pancreatectomy in PDAC management.
