Abstract
Background
We sought to provide a meta-analysis and credibility assessment of available randomized
controlled trials and propensity score matched studies when assessing early and oncologic
outcomes of laparoscopic distal pancreatectomy compared with open distal pancreatectomy.
Methods
The MEDLINE, Scopus, Web of Science, and Cochrane databases were searched for pertinent
literature up to June 2022. Random-effect meta-analyses were applied. Trial sequential
analysis was applied to verify whether results were true- or false-positive or -negative
findings.
Results
Thirteen studies were identified (2 randomized controlled trials and 11 propensity
score matched studies). The early outcomes were assessed on 12 studies, including
4,346 patients. In this population, laparoscopic distal pancreatectomy decreased postoperative
stay (mean difference = 1.8 days; P = .001) and estimated blood loss (mean difference = 148 mL; P = .001), and trial sequential analysis confirmed these as true-positive findings.
Laparoscopic distal pancreatectomy and open distal pancreatectomy had similar operating
times (P = .165), and trial sequential analysis confirmed this as a true-negative finding.
Major morbidity, mortality, and readmission were similar, but results were inconclusive
by trial sequential analysis. Oncologic outcomes were assessed on 5 studies, including
2,430 patients. In this population, laparoscopic distal pancreatectomy showed higher
R0 resection rate (OR = 1.46; P = .001) and shorter time to adjuvant therapy (mean difference 4.0 days P = .003). A survival benefit was observed at 1 year after laparoscopic distal pancreatectomy
(OR = 1.45; P = .001), which was not confirmed at 3 years (P = .650).
Conclusion
Laparoscopic distal pancreatectomy is superior to open distal pancreatectomy for most
of the early outcomes analyzed. The operating time was equalized as a result of the
learning curve. Results from patients with pancreatic cancer suggest at least an oncologic
noninferiority of laparoscopic distal pancreatectomy compared with open distal pancreatectomy.
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Article info
Publication history
Published online: December 21, 2022
Accepted:
November 21,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
