title: Does minimally-invasive pancreaticoduodenectomy have advantages over its open method? A meta-analysis of retrospective studies.
abstract: BACKGROUND
  While more and more open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Therefore, we carried out this meta-analysis to evaluate whether MIPD is safe, feasible and worthwhile.
  
  
  METHODS
  PubMed, EMBASE, and Cochrane Library were searched to identify studies published between January 1994 and November 2013 comparing MIPD with open pancreaticoduodenectomy (OPD). Intraoperative outcomes, oncologic safety, postoperative complications, and postoperative recovery were evaluated.
  
  
  RESULTS
  11 retrospective studies representing 869 patients (327 MIPDs, 542 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (MD -361.93 ml, 95% CI -519.22 to -204.63 ml, p<0.001, I(2) = 94%), wound infection (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007, I(2) = 0%), and hospital stay (MD -2.64 d, 95% CI -4.23 to -1.05 d, p = 0.001, I(2) = 78%). However, it brings longer operative time (MD 105 min, 95% CI 49.73 to 160.26 min, p<0.001, I(2) = 93%). There were no significant differences between the two procedures in likelihood of overall complications (p = 0.05), pancreatic fistula (PF) (p = 0.86), delayed gastric empting (DGE) (p = 0.96), positive surgical margins (p = 0.07), retrieval of lymph nodes (p = 0.48), reoperation (p = 0.16) and mortality (p = 0.64).
  
  
  CONCLUSIONS
  Our results suggest that MIPD is currently safe, feasible and worthwhile. But considering the selection bias, complexity of MIPD and lack of long-term oncologic outcomes, we suggest it be performed in a high-volume pancreatic surgery center in selected patients.
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
authors.forename: Han
authors.initials: H
authors.lastname: Qin
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital, Chongqing Medical University, Chongqing, P. R. China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
authors.forename: Yiyang
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
authors.forename: Gang
authors.initials: G
authors.lastname: Pan
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zeng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome