Background
Laparoscopic distal pancreatectomy is regarded as a feasible and safe surgical alternative
to open distal pancreatectomy for lesions of the pancreatic tail and body. The aim
of the present systematic review was to provide recommendations for clinical practice
and research on the basis of surgical morbidity, such as pancreas fistula, delayed
gastric empting, safety, and clinical significance of laparoscopic versus open distal
pancreatectomy for malignant and nonmalignant diseases of the pancreas.
Methods
A systematic literature search (MEDLINE) was performed to identify all types of studies
comparing laparoscopic distal pancreatectomy and open distal pancreatectomy. Random
effects meta-analyses were calculated after critical appraisal of the included studies
and presented as odds ratios or mean differences each with corresponding 95% confidence
intervals.
Results
A total of 4,148 citations were retrieved initially; available data of 29 observational
studies (3,701 patients overall) were included in the meta-analyses. Five systematic
reviews on the same topic were found and critically appraised. Meta-analyses showed
superiority of laparoscopic distal pancreatectomy in terms of blood loss, time to
first oral intake, and hospital stay. All other parameters of operative morbidity
and safety showed no difference. Data on oncologic radicality and effectiveness are
limited.
Conclusion
Laparoscopic distal pancreatectomy seems to be a safe and effective alternative to
open distal pancreatectomy. No more nonrandomized trials are needed within this context.
A large, randomized trial is warranted and should focus on oncologic effectiveness,
defined end points, and cost-effectiveness.
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Article info
Publication history
Accepted:
June 30,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.