Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and meta-analysis

Publication date: Available online 13 December 2018Source: European Journal of Surgical OncologyAuthor(s): Jony van Hilst, Maarten Korrel, Thijs de Rooij, Sanne Lof, Olivier R. Busch, Bas Groot Koerkamp, David A. Kooby, Susan van Dieren, Mo Abu Hilal, Marc G. Besselink, DIPLOMA study groupAbstractIn the absence of randomized trials, uncertainty regarding the oncologic efficacy of minimally invasive distal pancreatectomy (MIDP) remains. This systematic review aimed to compare oncologic outcomes after MIDP (laparoscopic or robot-assisted) and open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). Matched and non-matched studies were included. Pooled analyses were performed for pathology (e.g., microscopically radical (R0) resection and lymph node retrieval) and oncologic outcomes (e.g., overall survival). After screening 1760 studies, 21 studies with 11,246 patients were included. Overall survival (hazard ratio 0.86; 95% confidence interval (CI) 0.73 to 1.01; p = 0.06), R0 resection rate (odds ratio (OR) 1.24; 95%CI 0.97 to 1.58; p = 0.09) and use of adjuvant chemotherapy (OR 1.07; 95%CI 0.89 to 1.30; p = 0.46) were comparable for MIDP and ODP. The lymph node yield (weighted mean difference (WMD) −1.3 lymph nodes; 95%CI -2.46 to −0.15; p = 0.03) was lower after MIDP. Patients undergoing MIDP were more likely to have smaller tumors (WMD -0.46 cm; 95%CI -0.67 to −0.24; p 
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research

Related Links:

This study investigated whether postoperative outcomes and long-term survival after laparoscopic distal pancreatectomy are comparable to those after an open procedure. METHODS: This retrospective case-control study included patients who underwent distal pancreatectomy for resectable pancreatic adenocarcinoma between 2010 and 2013, identified from the National Cancer Database. Propensity score nearest-neighbour 1 : 1 matching was performed between patients undergoing laparoscopic or open distal pancreatectomy based on all relevant co-variables. The primary outcome was overall survival. RESULTS: Of 1947 eligible pa...
Source: The British Journal of Surgery - Category: Surgery Authors: Tags: Br J Surg Source Type: research
This study investigated whether postoperative outcomes and long‐term survival after laparoscopic distal pancreatectomy are comparable to those after an open procedure. MethodsThis retrospective case–control study included patients who underwent distal pancreatectomy for resectable pancreatic adenocarcinoma between 2010 and 2013, identified from the National Cancer Database. Propensity score nearest‐neighbour 1 : 1 matching was performed between patients undergoing laparoscopic or open distal pancreatectomy based on all relevant co‐variables. The primary outcome was overall survival. ResultsOf 1947 eligible pati...
Source: British Journal of Surgery - Category: Surgery Authors: Tags: Original article Source Type: research
Authors: Caruso F, Alessandri G, Cesana G, Castello G, Uccelli M, Ciccarese F, Giorgi R, Villa R, Scotto B, Olmi S Abstract OBJECTIVE: The tumors of the head of the pancreas are one of the leading causes of cancer-related death in Western countries. The current gold standard for these tumors is a Whipple procedure. This procedure did not change in its surgical steps since when it was initially introduced in 1935. More recently, a laparoscopic approach with similar outcomes has been described. The aim of this paper is to describe the laparoscopic surgical technique performed in our unit, reporting single center post...
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
This study aimed to develop a prognostic score to optimize prevention of an unnecessary laparotomy and minimize the rate for unnecessary laparoscopy.MethodsClinicopathologic data were evaluated for all patients undergoing surgical intervention for PDAC between 2001 and 2015, who were stratified into group 1 (2001 –2008) and group 2 (2009–2014).ResultsThe study identified 1001 patients eligible for analysis, 331 (33%) of whom underwent a staging laparoscopy before exploration. An unnecessary laparotomy was prevented for 44.4% of the patients in period 1 and for 24% of the patients in period 2 (p 
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
ConclusionWith modern-era neoadjuvant therapy, R0 resections can be achieved in a majority of non-metastatic patients with locally advanced, unresectable disease based on cross-sectional imaging.
Source: Journal of Gastrointestinal Surgery - Category: Surgery Source Type: research
This study aimed to develop a prognostic score to optimize prevention of an unnecessary laparotomy and minimize the rate for unnecessary laparoscopy. METHODS: Clinicopathologic data were evaluated for all patients undergoing surgical intervention for PDAC between 2001 and 2015, who were stratified into group 1 (2001-2008) and group 2 (2009-2014). RESULTS: The study identified 1001 patients eligible for analysis, 331 (33%) of whom underwent a staging laparoscopy before exploration. An unnecessary laparotomy was prevented for 44.4% of the patients in period 1 and for 24% of the patients in period 2 (p 
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Surg Oncol Source Type: research
Conclusions For patients with localized pancreatic adenocarcinoma, LPD provides short-term oncologic and long-term overall survival outcomes identical to OPD and is associated with decreased rates of readmission and a trend towards accelerated recovery.
Source: The American Journal of Surgery - Category: Surgery Source Type: research
Recently, InsideSurgery had a chance to speak with Dr. Charles J. Yeo about his career as a top Whipple and pancreas surgeon and his ongoing role as a surgical leader and educator. As the Samuel D. Gross Professor of Surgery and Chair of the Department of Surgery, you welcomed your second intern class to Thomas Jefferson University in Philadelphia, Pennsylvania last month. What one piece advice do you have for your new trainees? One piece of advice….that’s tough! Several pieces of advice….enjoy the challenges and experiences of internship; read and increase your k...
Source: Inside Surgery - Category: Surgery Authors: Tags: Interviews Source Type: blogs
Conclusion Survival after DP for PDAC is poor and is related to resection margin, tumor stage, surgical complications, and adjuvant chemotherapy. Further studies should assess to what extent prevention of surgical complications and more extensive use of adjuvant chemotherapy can improve survival.
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
CONCLUSION: Survival after DP for PDAC is poor and is related to resection margin, tumor stage, surgical complications, and adjuvant chemotherapy. Further studies should assess to what extent prevention of surgical complications and more extensive use of adjuvant chemotherapy can improve survival. PMID: 26508153 [PubMed - as supplied by publisher]
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Surg Oncol Source Type: research
More News: Adenocarcinoma | Cancer & Oncology | Chemotherapy | Laparoscopy | Pancreas | Pancreatic Cancer | Pathology | Study | Surgery