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Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies

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Abstract

Background

The current literature suggests that minimally invasive distal pancreatectomy (MIDP) is associated with faster recovery and less morbidity than open surgery. However, most studies have been limited by a small sample size and a single-institution design. To overcome this problem, the first metaanalysis of studies comparing MIDP and open distal pancreatectomy (ODP) has been performed.

Methods

A systematic literature review was conducted to identify studies comparing MIDP and ODP. Perioperative outcomes (e.g., morbidity and mortality, pancreatic fistula rates, blood loss) constituted the study end points. Metaanalyses were performed using a random-effects model.

Results

For the metaanalysis, 10 studies including 349 patients undergoing MIDP and 380 patients undergoing ODP were considered suitable. The patients in the two groups were similar with respect to age, body mass index (BMI), American Society of Anesthesiology (ASA) classification, and indication for surgery. The rate of conversion from full laparoscopy to hand-assisted procedure was 37%, and that from minimally invasive to open procedure was 11%. Patients undergoing MIDP had less blood loss, a shorter time to oral intake, and a shorter postoperative hospital stay. The mortality and reoperative rates did not differ between MIDP and ODP. The MIDP approach had fewer overall complications [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27–0.89], major complications (OR, 0.57; 95% CI, 0.34–0.96), surgical-site infections (OR, 0.32; 95% CI, 0.19–0.53), and pancreatic fistulas (OR, 0.68; 95% CI, 0.47–0.98).

Conclusions

The MIDP procedure is feasible, safe, and associated with less blood loss and overall complications, shorter time to oral intake, and shorter postoperative hospital stay. Furthermore, the minimally invasive approach reduces the rate of pancreatic leaks and surgical-site infections after ODP.

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Disclosures

Drs. Giuseppe R. Nigri, Alan S. Rosman, Niccolò Petrucciani, Alessandro Fancellu, Michele Pisano, Luigi Zorcolo, Giovanni Ramacciato, and Marcovalerio Melis have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, St. Andrea Hospital, Sapienza University of Rome, 5-Ovest, Via di Grottarossa 1035, 00189, Rome, Italy

    Giuseppe R. Nigri, Niccolò Petrucciani & Giovanni Ramacciato

  2. Department of Gastroenterology, Mount Sinai School of Medicine and Bronx VAMC, New York, NY, USA

    Alan S. Rosman

  3. Department of Surgery, University of Sassari, Sassari, Italy

    Alessandro Fancellu

  4. Department of Surgery, Ospedali Riuniti, Bergamo, Italy

    Michele Pisano

  5. Department of Surgery, University of Cagliari, Cagliari, Italy

    Luigi Zorcolo

  6. Department of Surgery, New York University Medical School, NY Harbor Healthcare System VAMC, New York, NY, USA

    Marcovalerio Melis

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  1. Giuseppe R. Nigri
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Correspondence to Giuseppe R. Nigri.

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Nigri, G.R., Rosman, A.S., Petrucciani, N. et al. Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc 25, 1642–1651 (2011). https://doi.org/10.1007/s00464-010-1456-5

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  • DOI: https://doi.org/10.1007/s00464-010-1456-5

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