Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic Versus Open Distal Pancreatectomy for Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic distal pancreatectomy was proposed as an oncologically safe approach for pancreatic ductal adenocarcinoma.

Methods

A systematic review of the studies comparing laparoscopic and open distal pancreatectomy was conducted. The primary endpoint was an R0 resection rate. The secondary endpoints were intra- and postoperative results, tumour size, mean harvested lymph node, number of patients eligible for adjuvant therapy and overall survival.

Results

Five comparative case control studies involving 261 patients (30.7 % laparoscopic and 69.3 % open) who underwent a distal pancreatectomy were included. The R0 resection rate was similar between the two groups (P = 0.53). The laparoscopic group had longer operative times (P = 0.04), lesser blood loss (P = 0.01), a shorter hospital stay (P < 0.001) and smaller tumour size (P = 0.04) as compared with the laparotomic group. Overall morbidity, postoperative pancreatic fistula, reoperation, mortality and number of patients eligible for adjuvant therapy were similar. The mean harvested lymph nodes were comparable in the two groups (P = 0.33). The laparoscopic approach did not affect the overall survival rate (P = 0.32).

Conclusion

Even if the number of patients compared is underpowered, the laparoscopic approach in the treatment of PDAC seems to be safe and efficacious. However, additional prospective, randomised, multicentric trials are needed to correctly evaluate the laparoscopic approach in PDAC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Nakamura M, Nakashima H. Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci. 2013;20(4):421–8

    Article  PubMed  Google Scholar 

  2. Jin T, Altaf K, Xiong JJ, Huang W, Javed MA, Mai G, Liu XB, Hu WM, Xia Q. A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB (Oxford). 2012;14(11):711–724.

    Article  Google Scholar 

  3. Pericleous S, Middleton N, McKay SC, Bowers KA, Hutchins RR. Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas. 2012;41(7):993–1000.

    Article  PubMed  Google Scholar 

  4. Sui CJ, Li B, Yang JM, Wang SJ, Zhou YM. Laparoscopic versus open distal pancreatectomy: a meta-analysis. Asian J Surg. 2012;35(1):1–8.

    Article  PubMed  Google Scholar 

  5. Xie K, Zhu YP, Xu XW, Chen K, Yan JF, Mou YP. Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: a meta-analysis. World J Gastroenterol. 2012 28;18(16):1959–1967.

  6. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 2012;255(6):1048–1059.

    Article  PubMed  Google Scholar 

  7. Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc. 2012;26(4):904–913.

    Article  PubMed  Google Scholar 

  8. Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF; Hepatobiliary and Pancreatic Section (HBPS) of the Royal Belgian Society of Surgery; Belgian Group for Endoscopic Surgery (BGES); Club Coelio. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients.Surgery. 2005;137(6):597–605.

    Article  PubMed  Google Scholar 

  9. Rosales-Velderrain A, Bowers SP, Goldberg RF, Clarke TM, Buchanan MA, Stauffer JA, Asbun HJ. National trends in resection of the distal pancreas. World J Gastroenterol. 2012; 28;18(32):4342–4349.

  10. Ricci C, Casadei R, Lazzarini E, Marielda D’Ambra, Buscemi S, Pacilio CA, Taffurelli G, Minni F Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis . Hepatobiliary Pancreat Dis Int 2014 [Epub ahead of print]

  11. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol.2010;25:603–605.

    Article  PubMed  Google Scholar 

  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux J, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 21;339:b2700.

  13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M; International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  15. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007; 8:16.

    Article  PubMed Central  PubMed  Google Scholar 

  17. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188

    Article  CAS  PubMed  Google Scholar 

  18. Fleiss JL. The statistical basis of meta-analysis. Stat Methods Med Res. 1993;2:121–145.

    Article  CAS  PubMed  Google Scholar 

  19. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002 15;21(11):1539–1558.

  20. Clarke M, Horton R. Bringing it all together: Lancet-Cochrane collaborate on systematic reviews. Lancet. 2001;357:1728.

    Article  CAS  PubMed  Google Scholar 

  21. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–2012.

    Article  CAS  PubMed  Google Scholar 

  22. Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD. A multicenter analysis of distal pancreatectomy for adenocarcinoma: Is laparoscopic resection appropriate? J Am Coll Surg. 2010; 210(5):779–787.

    Article  PubMed  Google Scholar 

  23. Magge D, Gooding W, Choudry H, Steve J, Steel J, Zureikat A, Krasinskas A, Daouadi M, Lee KK, Hughes SJ, Zeh HJ 3rd, Moser AJ. Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg. 2013;148(6):525–531.

    Article  PubMed  Google Scholar 

  24. Rehman S, John SK, Lochan R, Jaques BC, Manas DM, Charnley RM, French JJ, White SA. Oncological feasibility of laparoscopic distal pancreatectomy for adenocarcinoma: a single-institution comparative study. World J Surg. 2014;38(2):476–483.

    Article  CAS  PubMed  Google Scholar 

  25. Hu M, Zhao G, Wang F, Zhao Z, Li C, Liu R Laparoscopic versus open distal splenopancreatectomy for the treatment of pancreatic body and tail cancer: a retrospective, mid-term follow-up study at a single academic tertiary care institution.Surg Endosc. 2014;28(9):2584–2591.

    Article  PubMed  Google Scholar 

  26. Lee SH, Kang CM, Hwang HK, Choi SH, Lee WJ, Chi HS. Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes. Surg Endosc. 2014. [Epub ahead of print]

  27. Garrido MM, Kelley AS, Paris J, Roza K, Meier DE, Morrison RS, Aldridge MD. Methods for Constructing and Assessing Propensity Scores. Health Serv Res. 2014. [Epub ahead of print]

  28. Kuroki T, Eguchi S. Laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma. Surg Today. 2014. [Epub ahead of print]

  29. Kang CM, Lee SH, Lee WJ. Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: current status and future perspectives. World J Gastroenterol 7;20(9):2343–2351

  30. Sakpal TV Sample Size Estimation in Clinical Trial. Perspect Clin Res. 2010; 1(2): 67–69.

    PubMed Central  PubMed  Google Scholar 

  31. Valle JW, Palmer D, Jackson R, Cox T, Neoptolemos JP, Ghaneh P, Rawcliffe CL, Bassi C, Stocken DD, Cunningham D, O'Reilly D, Goldstein D, Robinson BA, Karapetis C, Scarfe A, Lacaine F, Sand J, Izbicki JR, Mayerle J, Dervenis C, Oláh A, Butturini G, Lind PA, Middleton MR, Anthoney A, Sumpter K, Carter R, Büchler MW. Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study. J Clin Oncol. 2014; 20;32(6):504–12.

  32. Ricci C, Casadei R, Buscemi S, Taffurelli G, D'Ambra M, Pacilio CA, Minni F. Laparoscopic distal pancreatectomy: what factors are related to the learning curve? Surg Today. 2014. [Epub ahead of print]

  33. Lee MK, Lewis RS, Strasberg SM, Hall BL, Allendorf JD, Beane JD, Behrman SW, Callery MP, Christein JD, Drebin JA, Epelboym I, He J, Pitt HA, Winslow E, Wolfgang C, Vollmer CM Jr. Defining the post-operative morbidity index for distal pancreatectomy. (HPB (Oxford). 2014; 16(10):915–923.

    Article  Google Scholar 

Download references

Conflict of Interest

All authors declare no conflict of interest

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università di Bologna, Policlinico S.Orsola-Malpighi Via Massarenti n, 9 40138, Bologna, Italy

    Claudio Ricci, Riccardo Casadei, Giovanni Taffurelli, Fabrizio Toscano, Carlo Alberto Pacilio, Selene Bogoni, Marielda D’Ambra, Nico Pagano & Francesco Minni

  2. Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Malpighi Hospital, Alma Mater Studiorum Univeristy of Bologna, Bologna, Italy

    Maria Cristina Di Marco

Authors
  1. Claudio Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Casadei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Taffurelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabrizio Toscano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlo Alberto Pacilio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Selene Bogoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marielda D’Ambra
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nico Pagano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria Cristina Di Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francesco Minni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Ricci.

Additional information

Claudio Ricci and Riccardo Casadei contributed equally to the realisation of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ricci, C., Casadei, R., Taffurelli, G. et al. Laparoscopic Versus Open Distal Pancreatectomy for Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis. J Gastrointest Surg 19, 770–781 (2015). https://doi.org/10.1007/s11605-014-2721-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-014-2721-z

Keywords

Search

Navigation