Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis

Abstract

BACKGROUND:The use of laparoscopic distal pancreatectomy (LDP) increased in the past twenty years but the real diffusion of this technique is still unknown as well as the type of centers (high or low volume) in which this procedure is more frequently performed. DATA SOURCE:

Full Robotic Distal Pancreatectomy: Safety and Feasibility Analysis of a Multicenter Cohort of 236 Patients

“…2,3 Despite the lack of randomized clinical trials, clear advantages have been demonstrated in terms of pain, intraoperative blood loss, and length of hospital stay over the open approach, with comparable oncological outcomes. [4][5][6][7][8] Nevertheless, limits to the widespread adoption of LDP include 2D (2-dimensional) imaging, limited ergonomics, fulcrum effect, and the absence of tactile sensation.…”

Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma

“…4,8,15 However, few analyses have focused on a minimally invasive DP approach specifically for the treatment of PDAC. 2,5,[7][8][9][10]17,18 This study expands on the minimal data which have been published. In particular, this study is among the largest to compare the minimally invasive approach for PDAC to open surgery with the inherent value of ACS-NSQIP data augmented by pancreatectomy specific variables to more accurately assess early postoperative outcomes.…”

“…28 Previous studies have reported discrepancies regarding tumor size being either significantly smaller or equivalent in MISDP vs. ODP. 7,27 One outstanding point from the surgical pathology data was that stage IV consisted of 4% and unknown surgical pathology consisted of 5% of the patients in this series. The explanation behind the presence of resected stage IV disease can be attributed to two likely reasons, either DP completed prior to intraoperative recognition of metastasis or possibly some surgeons performing distal pancreatectomy with metastasectomy.…”

“…18 The postoperative outcomes reported here are consistent with many previous studies. 2,7,8,18,27 Yet, the majority of published studies report DP for all diagnoses and are not focused specifically on PDAC. This analysis demonstrated that no difference was observed in mortality, but a significant difference was observed in morbidity, 31% in the MISDP and 42% in the ODP.…”

“…1 Several studies have shown that MISDP and ODP for PDAC have a similar harvest of lymph nodes, resection margin status, and mortality. 2,[4][5][6][7] Some analyses also have indicated a decrease in length of stay with the MIS approach. 2,7,8 The viability of MISDP as an alternative to ODP is reliant on equivalent, if not improved, postsurgical outcomes as well as successful tumor resection.…”