Meta-analysis of laparoscopic versus open distal pancreatectomy for pancreatic diseases

Abstract

Increasing studies have reported on the feasibility of laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for pancreatic diseases; however, the therapeutic efficacies between the two procedures remain controversial. The aim of the present study was to conduct a meta-analysis to evaluate the efficacy and safety of LDP for pancreatic diseases. Patients and Methods: Searches of the Medline, Embase, Cochrane Library, Chinese Biomedical Database, and CNKI were performed to identify relevant studies published between January 2001 and December 2011. Results: Sixteen studies involving 1796 participants were included. LDP was associated with longer operative time [mean difference (MD): -13.45, 95 per cent confidence interval (95 per cent CI): 8.18-18.17, P<0.00001] and fewer lymph nodes harvested (MD:-6.05, 95 per cent CI: -6.54 to -5.56, P<0.00001), but higher spleen preservation rates [odds ratio (OR): 3.38, 95 per cent CI: 1.93-5.9, P<0.00001], less estimated blood loss (MD: -389.75, 95 per cent CI: -407.96 to -371.55, P<0.00001), shorter hospital stay (MD: -3.95, 95 per cent CI: -4.0 to -3.9, P<0.00001) and less complications (OR: 0.47, 95 per cent CI: 0.25-0.88), P=0.02] compared with patients undergoing ODP. There were no significant differences between the two groups in postoperative mortality and long-term survival. Conclusion: The short-term outcomes of LDP for pancreatic diseases were comparable with the open approach. Although ODP might be associated with shorter operative time and more lymph nodes harvested, individuals considering LDP might benefit from a shorter hospital stay and a faster resumption without an increase in postoperative morbidity and mortality. © 2013 College of Surgeons of Hong Kong.