title: Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies.
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.
authors.affiliation: Department of Surgery, St. Andrea Hospital, Sapienza University of Rome, 5-Ovest, Via di Grottarossa 1035, 00189, Rome, Italy. giuseppe.nigri@uniroma1.it
authors.forename: Giuseppe R
authors.initials: GR
authors.lastname: Nigri
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rosman
authors.forename: Niccolò
authors.initials: N
authors.lastname: Petrucciani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fancellu
authors.forename: Michele
authors.initials: M
authors.lastname: Pisano
authors.forename: Luigi
authors.initials: L
authors.lastname: Zorcolo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Marcovalerio
authors.initials: M
authors.lastname: Melis
mesh_terms: D058733:Hand-Assisted Laparoscopy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications