A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: It's time to randomize

Mehrabi, Arianeb; Hafezi, Mohammadreza; Arvin, Jalal; Esmaeilzadeh, Majid; Garoussi, Camelia; Emami, Golnaz; Kössler‐Ebs, Julia; Müller‐Stich, Beat P.; Büchler, Markus W.; Hackert, Thilo; Diener, Markus K.

doi:10.1016/j.surg.2014.06.081

Cited by 252 publications

(198 citation statements)

References 54 publications

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“…From this large, multicenter matched cohort study, it became clear that LDP was not only feasible, but could also offer additional benefits as compared to the open approach. Since 2008, these findings have been corroborated by numerous single center [8][9][10][11][12] and multicenter reports [13,14], as well as those of several meta-analyses [4,15].…”

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confidence: 62%

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Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Kooby

Vollmer

2015

J Hepato Biliary Pancreat

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Laparoscopic approaches exist for most operations traditionally performed using open techniques, and an increasing number of organ resections are being performed laparoscopically. The potential benefits of laparoscopic over the open approach include reduced operative blood loss, fewer surgical complications, shorter hospital stays, and faster recovery times. Cholecystectomy and adrenalectomy are two such examples of organ resections more commonly performed laparoscopically than open in the United States, as the complexity of these operations is relatively low for experienced surgeons in properly selected patients. Laparoscopic colectomy had a slower evolution given the increased complexity of the procedure, but the value of the laparoscopic approach was demonstrated through several multicenter randomized trials [1,2], facilitated by the relatively large number of colectomies performed annually.Momentum for minimally invasive pancreatectomy (MIP) has been slower -likely due to the retroperitoneal location of the organ, its intimate relationship with the main mesenteric vessels, the complexity of the surgery, the inherent risk of postoperative pancreatic fistula (POPF) formation, and the relatively lower volume of cases, as compared with cholecystectomy and colectomy [3]. Of pancreatic resections, distal pancreatectomy (DP) is the most commonly achieved laparoscopically [4]. First reported in 1994, laparoscopic distal pancreatectomy (LDP) is being performed with increasing frequency worldwide despite a lack of randomized data supporting this approach over standard open distal pancreatectomy (ODP). Approximately one quarter of all DPs are performed using minimally invasive approaches [5].Drs Nakamura and colleagues from 69 medical centers in Japan used a sophisticated statistical method (propensity score matching -PSM) to address the comparison of two surgical techniques (LDP and ODP) for removing the left side of the pancreas [6]. The key findings between the two cohorts after PSM are that compared with ODP, LDP is associated with lower blood loss (254 ± 384 vs. 499 ± 740, <0.001), fewer blood transfusion (4% vs. 6.8%, P = 0.02), fewer grade B and C POPF (18.4% vs. 28.2%, P < 0.001), a higher percentage of splenic preservations (29.9% vs. 13.2%, P < 0.001), and shorter hospital stays (18.8 ± 14.7 vs. 23.2 ± 18.8, P = 0.001). In great part, these results support data from prior studies.In 2008 Results of this study demonstrated that there were no significant differences in OR time (216 vs. 230 min; P = 0.3), development of major pancreatic fistula (18% vs. 11%; P = 0.1), major complication (17% vs. 10%; P = 0.08), or 30-day mortality (1% vs. 0%; P = 0.040) between the groups (ODP vs. LDP, respectively). As compared with ODP, LDP was associated with lower estimated blood loss

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confidence: 62%

“…Of pancreatic resections, distal pancreatectomy (DP) is the most commonly achieved laparoscopically [4]. First reported in 1994, laparoscopic distal pancreatectomy (LDP) is being performed with increasing frequency worldwide despite a lack of randomized data supporting this approach over standard open distal pancreatectomy (ODP).…”

mentioning

confidence: 99%

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Kooby

Vollmer

2015

J Hepato Biliary Pancreat

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“…Ductal adenocarcinomas and pancreatic tumors, however, have been treated more often with ODP. Mucinous cystic neoplasias have been treated much more often with LDP (13). Because of the concern about achieving good oncological outcomes, LDP has been thought to be contraindicated in patients with malignant disease.…”

Section: Indicationsmentioning

confidence: 99%

Laparoscopic distal pancreatectomy

et al. 2016

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“…In the literature there are many papers that demonstrate the advantages of LDP versus open distal pancreatectomy (ODP) in terms of severe complication reduction according to Clavien-Dindo classification (3), reduction of blood loss and shorter length of hospital stay (4)(5)(6)(7)(8). There are no differences between the two techniques in terms of postoperative pancreatic fistula (POPF) development.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous laparoscopic resection of distal pancreas and liver nodule for pancreatic neuroendocrine tumor

Passuello¹,

Valmasoni²,

Pozza³

et al. 2016

J. Vis. Surg.

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A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: It's time to randomize

Cited by 252 publications

References 54 publications

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Laparoscopic distal pancreatectomy

Simultaneous laparoscopic resection of distal pancreas and liver nodule for pancreatic neuroendocrine tumor

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