Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Inclusion and Exclusion Criteria
2.3. Literature Search Strategy
2.4. Study Selection and Quality Assessment
2.5. Data Extraction and Analysis
3. Results
3.1. Literature Search and Selection
3.2. First Study: LPD vs. OPD in Elderly
3.3. Second Study: Outcome of LPD in the Elderly vs. Non-Elderly Patients
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Source | Period | Type of Study | Nr of Pt | Age of Cut Off | Approach | Median Age | ASA Score Class or Mean ± SD | Type of Pathology | Tumour Size (cm, IQR or ±SD) |
---|---|---|---|---|---|---|---|---|---|
Tan [18] | 2015–2019 | R | 56/28 | ≥0 | LPD OPD | 75.2 (±4.4) 74.7 (±4.6) | II 37/19 III 19/9 | PC 21/11 CC 31/4 AC 2/3 DC 8/4 | 2.5 (1.9–4.3) 3.3 (2.0–4.0) |
Liang [19] | 2015–2018 | R | 27/19 | ≥70 | LPD OPD | 74 (±4) 76 (±5) | II 19/8 III 18/8 | PC 12/15 AC 12/2 | 2.6 (±1) 3.1 (±1) |
Chapman [20] | 2010–2013 | R | 248/1520 | ≥75 | LPD OPD | 79.6 (±3.5) 79.5 (±3.4) | N/A | PC 248/1520 | <2: 25/125 2–4: 169/1002 >4: 49/329 |
Tee [21] | 2007–2014 | R | 113/225 | ≥70 | LPD OPD | 76.5 (±4.3) 76.4 (±4.5) | I-II 30/67 III-IV 83/158 | PC 53/121 CC 4/15 AC 9/33 DC 2/11 | N/A |
Shin [22] | 2014–2017 | R | 56/270 | ≥70 | LPD OPD | 74.8 (±3.7) 74.6 (±3.5) | 2.1± 0.5 2.1±0.4 | PC 14/115 CC 19/92 | N/A |
Source | Period | Type of Study | Nr of Pt | Age of Cut Off | Median Age | Type of Pathology | ASA Score Class or Mean ± SD | Tumor Size (cm, IQR or ±SD) |
---|---|---|---|---|---|---|---|---|
Tan [18] | 2015–2019 | R | 56/84 | ≥70 | 75.2 (±4.4) 60.7 (±7.5) | PC 21/22 CC 31/20 AC 2/1 DC 8/13 | II 37/66 III 19/18 | 2.5 (1.9–4.3) 2.2 (1.7–3.0) |
Liang [19] | 2015–2018 | R | 27/55 | ≥70 | 74 (±4) 59 (±9) | PC 12/18 AC 12/17 | II 19/42 III 8/1 | 2.6 (±1) 2.8 (±1.4) |
(a) | Postoperative mortality rate at 30 days | |
(b) | Readmission rate in hospital | |
(c) | Mortality rate at 90 days | |
(d) | Clavien–Dindo I/II complications | |
(e) | Clavien–Dindo III-V complications | |
(f) | Delayed gastric emptying | |
(g) | Pancreatic fistula grade B/C | |
(h) | Complete resection (R0) | |
(i) | Reoperation for complications | |
(j) | Blood loss |
(a) | Mortality rate at 90 days | |
(b) | Readmission rate in hospital | |
(c) | Clavien–Dindo III-V complications | |
(d) | Clavien–Dindo I/II complications | |
(e) | Conversion rate | |
(f) | Delayed gastric emptying | |
(g) | Pancreatic fistula grade B/C | |
(h) | Complete resection (R0) | |
(i) | Reoperation for complications | |
(j) | Blood loss |
Article | Selection | Comparability | Outcome | Score (Risk of Bias) | |||||
---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ||
Tan et al. | ☆ | ☆ | ☆ | / | ☆ | ☆ | ☆ | ☆ | 7 (low) |
Liang et al. | ☆ | ☆ | ☆ | / | ☆ | ☆ | ☆ | ☆ | 7 (low) |
Chapman et al. | ☆ | ☆ | ☆ | / | ☆ | ☆ | ☆ | ☆ | 7 (low) |
Tee et al. | ☆ | ☆ | ☆ | / | ☆ | ☆ | ☆ | ☆ | 7 (low) |
Shin et al. | ☆ | ☆ | ☆ | / | ☆ | ☆ | ☆ | ☆ | 7 (low) |
Benefits | Disadvantages | |
---|---|---|
Laparoscopic approach | Reduced postoperative pain Decreased hospital length of stay Improved mobilization Faster return to normal activity Fewer abdominal wall complications Lower rates of readmissions related to gastrointestinal, wound complications and malignancy and subsequently lower costs | More challenging based on technical aspects, with a longer learning curve for surgeons experienced with open approach Carbon dioxide pneumoperitoneum used in laparoscopic approach might lead to acidosis, produce changes in pulmonary mechanics, induce alteration in hemodynamic function and increase the risk of aspiration |
Open surgery | Standardized procedures Established training | More blood loss compared with laparoscopy Increased postoperative pain, considering the large incision of abdominal wall Increased hospital length of stay Abdominal wall complications Increased recovery time compared with laparoscopy |
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Bartos, A.; Mărgărit, S.; Bocse, H.; Krisboi, I.; Iancu, I.; Breazu, C.; Plesa-Furda, P.; Brînzilă, S.; Leucuta, D.; Iancu, C.; et al. Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis. Life 2022, 12, 1810. https://doi.org/10.3390/life12111810
Bartos A, Mărgărit S, Bocse H, Krisboi I, Iancu I, Breazu C, Plesa-Furda P, Brînzilă S, Leucuta D, Iancu C, et al. Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis. Life. 2022; 12(11):1810. https://doi.org/10.3390/life12111810
Chicago/Turabian StyleBartos, Adrian, Simona Mărgărit, Horea Bocse, Iulia Krisboi, Ioana Iancu, Caius Breazu, Patricia Plesa-Furda, Sandu Brînzilă, Daniel Leucuta, Cornel Iancu, and et al. 2022. "Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis" Life 12, no. 11: 1810. https://doi.org/10.3390/life12111810