The Long-Term Prognosis Of Minimally Invasive Versus Open Distal Pancreatectomy For Pancreatic Ductal Adenocarcinoma: A Systematic Review And Meta-Analysis

Aims:Surgical resection remains the preferred treatment for malignant pancreatic diseases at present,but the long-term survival of pancreatic ductal adenocarcinoma(PDAC)using minimally invasive distal pancreatectomy(MIDP)and open distal pancreatectomy(ODP)remains controversial.Therefore,we evaluated the long-term survival of MIDP versus ODP in treating patients with PDAC by means of Meta-analysis to obtain evidence-based evidence for clinical decision making.METHODS:The literature on MIDP versus ODP for PDAC was collected in Pubmed,Web of Science,The Cochrane Library,Embase,Wanfang,VIP database,and Zhiwang databases,and the search time frame was for Chinese and English articles published between 2010 and March 2023.Meta-analysis was performed using Rev Man 5.4software after 2 investigators independently screened the literature,extracted information,and evaluated the risk of bias in the included studies.RESULTS:The primary study outcome indicators were long-term survival,including overall survival time(OS),disease-free survival(DFS),and progression-free survival time(PFS).Twenty-three studies with a total of 11055 patients(MIDP: 3358,ODP: 7697)were included.Results of the Meta-analysis showed that MIDP had a longer overall survival time(WMD: 5.22;95% CI: 1.23,9.21;P = 0.01)and a 3-year DFS rate(HR:0.76;95% CI: 0.61,0.94;P = 0.01)and a higher R0 resection rate(OR: 1.53;95% CI:1.33,1.75;P < 0.00001),risk of intraoperative bleeding(WMD:-186.19;95% CI:-258.23,-114.15;P < 0.00001),length of hospital stay(WMD:-1.89;95% CI:-2.34,-1.43;P < 0.00001)and peripheral nerve invasion rate(OR: 0.76;95% CI: 0.60,0.97;P = 0.03)were reduced;while there were no statistical differences between the two techniques in 3-year OS rate,5-year OS rate,5-year DFS rate,operation time,number of lymph nodes obtained,positive lymph node rate,clinically relevant postoperative pancreatic fistula rate,overall recurrence rate,and receipt of adjuvant chemotherapy(P > 0.05).CONCLUSION:MIDP improves overall survival time,3-year DFS rate,R0 resection rate,reduces bleeding risk,and shortens hospital stay.However,the presence of selective bias,high R0 resection rate,low number of lymph nodes detected and absence of local recurrence rate make the above findings need to be validated by multicenter,large sample randomized controlled trial.