Long-Term Oncological Outcomes in Laparoscopic Versus Open Pancreaticoduodenectomy for Pancreatic Cancer: A Systematic Review and Meta-Analysis

Background: Short-term outcomes after laparoscopic pancreaticoduodenectomy (LPD) seem promising, but long-term outcomes of LPD for pancreatic cancer (PC) warrant further investigation. Methods: A systematic research of various databases was performed to identify studies analyzing long-term outcomes in LPD versus open pancreaticoduodenectomy (OPD) for PC. Survival parameters of overall survival (OS) and disease-free survival (DFS) were extracted. The search was last conducted before May 23, 2018. Results: A total of 10 studies involving 11,180 patients (1437 in LPD and 9743 in OPD) met the final inclusion criteria. Pooled analyses showed that LPD was associated with longer DFS compared with OPD (hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.61 to 0.98, P = .033). No significant difference in OS was found between LPD and OPD (HR: 0.98, 95% CI: 0.90 to 1.07, P = .672). In addition, patients of LPD had much shorter time to receive postoperative adjuvant chemotherapy compared with OPD (weighted mean difference: -10.17, 95% CI: -17.90 to -2.45, P = .010). Discussion: With regard to long-term survival, LPD is comparable with OPD for PC. Furthermore, LPD is associated with longer DFS compared with OPD. Future well-designed, randomized controlled trials with longer follow-up are still essential to further demonstrate the advantages of LPD for PC.