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Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies

Nigri, Giuseppe R. and Rosman, Alan Steven and Petrucciani, Niccolò and Fancellu, Alessandro and Pisano, Michele and Zorcolo, Luigi and Ramacciato, Giovanni and Melis, Marcovalerio (2011) Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surgical Endoscopy, Vol. 25 (5), p. 1642-1651. ISSN 0930-2794. eISSN 1432-2218. Article.

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DOI: 10.1007/s00464-010-1456-5

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.

Item Type:Article
ID Code:6126
Status:Published
Refereed:Yes
Uncontrolled Keywords:Distal pancreatectomy, minimally invasive pancreatectomy
Subjects:Area 06 - Scienze mediche > MED/18 Chirurgia generale
Divisions:001 Università di Sassari > 01 Dipartimenti > Medicina clinica, sperimentale e oncologica
Publisher:Springer New York
ISSN:0930-2794
eISSN:1432-2218
Copyright Holders:© Springer Science+Business Media, LLC 2010
Deposited On:09 Jun 2011 10:48

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