Abstract
Background
Minimally invasive total pancreatectomy (MITP) is considered safe and feasible with
limited evidence on this procedure. The aim of this study was to systematically analyze
the current literature on MITP compared to open TP (OTP).
Method
Randomized controlled trials and prospective non-randomized comparative studies were
sought systematically in MEDLINE, Web of Science and CENTRAL from their inception
until December 2021. Outcome measures included operative time, length of hospital
stay (LOH), spleen-preservation rate, estimated blood loss (EBL), need for transfusion,
venous resection rate, delayed gastric emptying (DGE), biliary leakage, postpancreatectomy
hemorrhage (PPH), reoperation rate, overall 30-day morbidity (Clavien-Dindo > IIIa),
90-day mortality, 90-day readmission, examined lymph nodes (ELN). Pooled results are
presented as odds ratios (OR) or mean difference (MD) with 95% confidence interval
(CI).
Results
7 observational studies with a total of 4212 patients were included. MITP had a decreased
EBL and transfusion rate, lower 30-day morbidity and 90-day mortality with a longer
LOH compared to OTP. There were no significant differences regarding operative time,
spleen preservation rate, DGE, biliary leakage, venous resection rate, PPH, reoperation,
90-day readmission and ELN.
Discussion
Based on the available studies, MITP is safe and feasible compared to OTP in highly
experienced hands from high-volume centers. Further high-quality studies are needed
to verify the conclusion.
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References
- Total pancreatectomy for hyperinsulinism due to an islet-cell adenoma: survival and cure at sixteen MOnths after operation presentation of metabolic studies.Ann Surg. 1944 Feb; 119: 211-221
- Cancer of the pancreas; a plea for total pancreatectomy.Am J Surg. 1954; 87: 20-33
- Carcinoma of the pancreatico-duodenal area; operability and choice of procedure.Ann Surg. 1958; 148: 711-723
- Total pancreatectomy.Ann Surg. 1970; 172: 595-604
- Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery.Br J Surg. 1994 Jan; 81: 102-107
- Total pancreatectomy for cancer of the pancreas: is it appropriate?.World J Surg. 1996; 20 (discussion 294): 288-293
- Total pancreatectomy for presumed intraductal papillary mucinous neoplasms: a multicentric study of the French surgical association (AFC).Ann Surg. 2018 Nov; 268: 823-830
- Outcome and long-term quality of life after total pancreatectomy (PANORAMA): a nationwide cohort study.Surgery. 2019 Dec; 166: 1017-1026
- Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation.Ann Surg. 2015; 261: 537-546
- Reappraisal of total pancreatectomy in 45 patients with pancreatic ductal adenocarcinoma in the modern era using matched-pairs analysis: multicenter study group of pancreatobiliary surgery in Japan.Pancreas. 2016; 45: 1003-1009
- Total pancreatectomy for the treatment of pancreatic neoplasms.ANZ J Surg. 2014; 84: 823-826
- Categorization of differing Types of total pancreatectomy.JAMA Surg. 2021 Nov 17; e215834
- The miami International evidence-based guidelines on minimally invasive pancreas resection.Ann Surg. 2020 Jan; 271: 1-14
- International consensus statement on robotic pancreatic surgery.Hepatobiliary Surg Nutr. 2019 Aug; 8: 345-360
- Laparoscopic pancreatectomy: report of 22 cases.Ann Chir. 2003 Sep; 128: 452-456
- Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience.Surg Endosc. 2010 Jul; 24: 1646-1657
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021 Mar 29; 372: n71
https://www.math.hkbu.edu.hk/∼tongt/papers/median2mean.html .
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med Res Methodol. 2014; 14: 135
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004 Aug; 240: 205-213
- Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).Surgery. 2007 Nov; 142: 761-768
- Postpancreatectomy hemorrhage (PPH): an International study group of pancreatic surgery (ISGPS) definition.Surgery. 2007 Jul; 142: 20-25
- ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.BMJ. 2016; 355: i4919
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019 Aug 28; 366: l4898
- Measuring inconsistency in meta-analyses.BMJ. 2003 Sep 6; 327: 557-560
- Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis.BMJ. 2001 Jul 14; 323: 101-105
- Robotic versus open total pancreatectomy: a retrospective cohort study.Langenbeck's Arch Surg. 2021 Nov; 406: 2325-2332
- Robotic total pancreatectomy with splenectomy: technique and outcomes.Surg Endosc. 2018 Aug; 32: 3691-3696
- Laparoscopic-assisted versus open total pancreatectomy and islet autotransplantation: a case-matched study of pediatric patients.J Pediatr Surg. 2020 Mar; 55: 558-563
- Laparoscopic robot-assisted versus open total pancreatectomy: a case-matched study.Surg Endosc. 2015 Jun; 29: 1425-1432
- Robotic-assisted versus open total pancreatectomy: a propensity score-matched study.Hepatobiliary Surg Nutr. 2020 Dec; 9: 759-770
- Feasibility and safety of robotic-assisted total pancreatectomy: a pilot western series.Updates Surg. 2021 Jun; 73: 955-966
- Outcomes after minimally invasive versus open total pancreatectomy: a pan-European propensity score matched study.Ann Surg. 2021 Jul 14;
- Total pancreatectomy and islet autotransplantation for chronic pancreatitis.J Am Coll Surg. 2012 Apr; 214 (discussion 424-6): 409-424
- Is there still a role for total pancreatectomy?.Ann Surg. 2007 Dec; 246 (discussion 974-5): 966-974
- Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis.J Am Coll Surg. 2005 Nov; 201: 680-687
- Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes.Ann Surg. 2014 Jul; 260: 56-64
- Perioperative and oncological outcomes following minimally invasive versus open pancreaticoduodenectomy for pancreatic duct adenocarcinoma.Surg Endosc. 2021 May; 35: 2273-2285
- The role of older age and obesity in minimally invasive and open pancreatic surgery: a systematic review and meta-analysis.Pancreatology. 2020 Sep; 20: 1234-1242
- Robotic central pancreatectomy: a systematic review and meta-analysis.HPB. 2021 Sep 24; S1365–182X: 1634-1638
- The Landmark series: minimally invasive pancreatic resection.Ann Surg Oncol. 2021 Mar; 28: 1447-1456
- Long-term outcomes after total pancreatectomy: special reference to survivors' living conditions and quality of life.World J Surg. 2015; 39: 1231-1239
- A contemporary evaluation of the cause of death and long-term quality of life after total pancreatectomy.World J Surg. 2016; 40: 2513-2518
- Systematic review of functional outcome and quality of life after total pancreatectomy.Br J Surg. 2019; 106: 1735-1746
- Clinical outcomes after total pancreatectomy: a prospective multicenter pan-European snapshot study.Ann Surg. 2020 Nov 9;
- Up-to-date comparison of robotic-assisted versus open distal pancreatectomy: a PRISMA-compliant meta-analysis.Medicine (Baltim). 2020 Jun 5; 99e20435
- Comparison of 3 minimally invasive methods versus open distal pancreatectomy: a systematic review and network meta-analysis.Surg Laparosc Endosc Percutaneous Tech. 2020 Sep 2; 31: 104-112
- Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis.Sci Rep. 2021 Feb 12; 11: 3774
- The role of the robot-assisted procedure during total pancreatectomy: a viewpoint.Hepatobiliary Surg Nutr. 2021 Jun; 10: 405
- Learning curve of three European centers in laparoscopic, hybrid laparoscopic, and robotic pancreatoduodenectomy.Surg Endosc. 2022 Feb; 36: 1515-1526
- The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre.HPB. 2015 Jul; 17: 580-586
Article info
Publication history
Published online: February 08, 2023
Accepted:
January 27,
2023
Received:
June 23,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
