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Laparoscopic distal pancreatectomy: many meta-analyses, few certainties

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Abstract

In recent years, an increasing of the level of evidence occurred with a significant number of meta-analyses. A question remains open: can LDP be considered the “new gold standard” for benign and malignant body–tail pancreatic disease? A systematic literature search was conducted to identify all meta-analyses published up to 2016. The primary endpoint was to evaluate the clinical safety of LDP. The secondary endpoints were to evaluate: the length of hospital stay (LOS), readmission rate, postoperative pancreatic fistula (POPF), overall postoperative morbidity and oncologic safety. Nine studies were found to be suitable for the analysis. Data regarding clinical safety were extractable in all meta-analyses but a “between study” homogeneity was available only in 7. The safety of LDP was sustained by six meta-analyses in benign/low grade of malignancy body–tail pancreatic lesions, by one in ductal adenocarcinoma (PDAC). LDP has a shorter LOS compared to open distal pancreatectomy (ODP), demonstrated by three meta-analyses. Readmission rate in LDP procedures was lower than in ODP; these data are sustained by one meta-analysis. LDP is not inferior to ODP regarding the occurrence of POPF (seven meta-analyses); overall morbidity rate was lower in LDP than ODP for benign or low-grade malignant tumor. The use of the LDP in PDAC is sustained from one study. In conclusion, LDP can be considered a safe alternative to ODP. LDP could have some advantages but the data do not permit to define this procedure as the first choice or as the new gold standard.

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References

  1. Cuschieri A, Jakimowicz JJ, van Spreeuwel J (1996) Laparoscopic distal 70 % pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223(3):280–285

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Mellinger JD, Ponsky JL (1996) Recent publications in laparoscopic surgery: an overview. Endoscopy 28(5):441–451

    Article  CAS  PubMed  Google Scholar 

  3. Kang CM (2015) Should we randomize our patients in the name of the “scientific evidence”? Surgery 158(6):1742–1743

    Article  PubMed  Google Scholar 

  4. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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 (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

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

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zhang J, Yu KF. What’s the relative risk? (1998) A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 18;280(19):1690–1691

  8. Goldet G, Howick J (2013) Understanding GRADE: an introduction. J Evid Based Med. 6(1):50–54

    Article  PubMed  Google Scholar 

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

  10. Russo MK (2007) How to review a meta-analysis. Gastroenterol Hepatol (N Y) 3(8):637–642

    Google Scholar 

  11. Yu X, Li H, Jin C, Fu D, Di Y, Hao S, Li J (2015) Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg 400(2):183–191

    Article  PubMed  Google Scholar 

  12. Richards ML, Thompson GB, Farley DR, Kendrick ML, Service JF, Vella A, Grant CS (2011) Setting the bar for laparoscopic resection of sporadic insulinoma. World J Surg 35(4):785–789

    Article  PubMed  Google Scholar 

  13. Ricci C, Casadei R, Lazzarini E, D’Ambra M, Buscemi S, Pacilio CA, Taffurelli G, Minni F (2014) Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 13(5):458–463

    Article  PubMed  Google Scholar 

  14. Mesleh MG, Stauffer JA, Asbun HJ (2013) Minimally invasive surgical techniques for pancreatic cancer: ready for prime time? J Hepatobiliary Pancreat Sci 20(6):578–582

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. Nigri GR, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2011) Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies.Surg Endosc. 25(5):1642–1651

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

    Article  PubMed  Google Scholar 

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

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  22. Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci 20(4):421–428

    Article  PubMed  Google Scholar 

  23. Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kössler-Ebs J, Müller-Stich BP, Büchler MW, Hackert T, Diener MK (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize? Surgery 157(1):45–55

    Article  PubMed  Google Scholar 

  24. Ricci C, Casadei R, Taffurelli G, Toscano F, Pacilio CA, Bogoni S, D’Ambra M, Pagano N, Di Marco MC, Minni F (2015) Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. J Gastrointest Surg 19(4):770–781

    Article  PubMed  Google Scholar 

  25. Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8(5):408–410

    Article  CAS  PubMed  Google Scholar 

  26. Balzano G, Bissolati M, Boggi U, Bassi C, Zerbi A, Falconi M; AISP Study Group on Distal Pancreatectomy (2014) A multicenter survey on distal pancreatectomy in Italy: results of minimally invasive technique and variability of perioperative pathways. Updates Surg 66(4):253–463

  27. de Rooij T, Klompmaker S, Abu Hilal M, Kendrick ML, Busch OR, Besselink MG (2016) Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol 13(4):227–238

    Article  CAS  PubMed  Google Scholar 

  28. Nappo G, Perinel J, El Bechwaty M, Adham M (2016) Minimally Invasive Pancreatic Resection: Is It Really the Future? Dig Surg 33(4):284–289

  29. Braga M, Ridolfi C, Balzano G et al (2012) Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updates Surg 64:179–183

    Article  PubMed  Google Scholar 

  30. Ricci C, Casadei R, Buscemi S, Taffurelli G, D’Ambra M, Pacilio CA, Minni F (2015) Laparoscopic distal pancreatectomy: what factors are related to the learning curve? Surg Today 45(1):50–56

    Article  PubMed  Google Scholar 

  31. Gooiker GA, van Gijn w, Wouters MW, Post van de PN, Velde CJ, Tollenaar RA, Signalling Committee Cancer of the Dutch Cancer Society (2011) Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg 98(4):485–494

    Article  CAS  PubMed  Google Scholar 

  32. Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776):1514–1522

  33. Shubert CR, Kendrick ML, Thomsen KM, Farnell MB, Habermann EB (2015) Identification of risk categories for in pancreaticoduodenectomy based on diagnosis. HPB (Oxford). 17(5):428–437

    Article  PubMed  Google Scholar 

  34. Pauker SG, Kassirer JP (1975) Therapeutic decision making: a cost-benefit analysis. N Engl J Med 293(5):229–234

    Article  CAS  PubMed  Google Scholar 

  35. Ricci C, Casadei R, Taffurelli G, Bogoni S, D’Ambra M, Ingaldi C, Pagano N, Pacilio CA, Minni F (2015) Laparoscopic distal pancreatectomy in benign or premalignant pancreatic lesions: is it really more cost-effective than open approach? J Gastrointest Surg. 19(8):1415–1524

    Article  PubMed  Google Scholar 

  36. 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 (2014) 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 32(6):504–512

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Authors and Affiliations

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

    Claudio Ricci, Riccardo Casadei, Giovanni Taffurelli, Carlo Alberto Pacilio & Francesco Minni

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  1. Claudio Ricci
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  2. Riccardo Casadei
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  3. Giovanni Taffurelli
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  4. Carlo Alberto Pacilio
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  5. Francesco Minni
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Correspondence to Claudio Ricci.

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Ricci, C., Casadei, R., Taffurelli, G. et al. Laparoscopic distal pancreatectomy: many meta-analyses, few certainties. Updates Surg 68, 225–234 (2016). https://doi.org/10.1007/s13304-016-0389-5

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  • DOI: https://doi.org/10.1007/s13304-016-0389-5

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