Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta‐analysis of laparoscopic pancreatectomy

Abstract

Background/purpose This study was performed to evaluate the outcomes of laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreatoduodenectomy (LPD) compared with the open method using meta-analysis. Methods A literature search was performed to identify comparative studies of laparoscopic versus open pancreatectomy. Perioperative outcomes were evaluated by metaanalysis using a fixed effect model and random effects model. Results Twenty-four studies of LDP and three studies of LPD matched the selection criteria, including 2,904 patients of DP and 109 patients of PD. Compared with ODP, LDP showed statistically significant differences with respect to less blood loss, lower transfusion rates, lower wound infection rates, lower morbidity rates, and shorter hospital stays. LPD showed significantly longer operative times compared with OPD. There was no significant difference in oncological outcomes between laparoscopic pancreatectomy and the open technique. Conclusions This meta-analysis included the largest number of patients and number of articles comparing LDP and ODP, and LDP showed significantly better perioperative outcomes. This meta-analysis suggests that LDP is a reasonable operative method for benign tumors and some ductal carcinomas in the pancreas.

Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach

“…21,22 Recently, a systematic review of 707 patients undergoing laparoscopic pancreaticoduodenectomy reported an R1 resection rate of 42.5%. 23 Our oncological outcomes with HLAPD compare favourably to these standards (R1 resection rate 30%) and confirm the oncologic soundness of the hybrid method. In our study, lymph node retrieval and R1 resection rates did not differ between the OPD and HLAPD groups, further corroborating the adequacy of laparoscopic resection.…”

Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: A two-center comparative study

“…Laparoscopic distal pancreatectomy (LDP) was first reported by Cuschieri (1994). Since then, several case series (Melotti et al, 2007;Taylor et al, 2008;Song et al, 2011), comparative cohort studies (Mabrut et al, 2005;Kooby et al, 2008;Jayaraman et al, 2010), and meta-analysis reports (Jusoh and Ammori, 2012;Pericleous et al, 2012;Xie et al, 2012;Nakamura and Nakashima, 2013) (Fox et al, 2012;Kneuertz et al, 2012;Venkat et al, 2012).…”

Perioperative management of distal pancreatectomy

“…Laparoscopic techniques have been recently applied to hepato-pancreato-biliary surgery [25] , so there are many studies reporting on the use of laparoscopic DP. Laparoscopic DP is used for resection of benign tumors and some ductal carcinomas of the pancreas [25] .…”

“…Laparoscopic DP is used for resection of benign tumors and some ductal carcinomas of the pancreas [25] . Systematic reviews have demonstrated that laparoscopic DP leads to significantly more favorable perioperative outcomes [20,25] .…”

“…Laparoscopic DP is used for resection of benign tumors and some ductal carcinomas of the pancreas [25] . Systematic reviews have demonstrated that laparoscopic DP leads to significantly more favorable perioperative outcomes [20,25] . Robotic DP is also available and safe for pancreatic surgery, but the influence of the technique on overall survival of oncology patients is still unknown [26] .…”