title: Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) by using meta-analytical techniques.
  
  
  BACKGROUND
  LDP is increasingly performed as an alternative approach for distal pancreatectomy in selected patients. Multiple studies have tried to assess the safety and efficacy of LDP compared with ODP.
  
  
  METHODS
  A systematic review of the literature was performed to identify studies comparing LDP and ODP. Intraoperative outcomes, postoperative recovery, oncologic safety, and postoperative complications were evaluated. Meta-analysis was performed using a random-effects model.
  
  
  RESULTS
  Eighteen studies matched the selection criteria, including 1814 patients (43% laparoscopic, 57% open). LDP had lower blood loss by 355 mL (P < 0.001) and hospital length of stay by 4.0 days (P < 0.001). Overall complications were significantly lower in the laparoscopic group (33.9% vs 44.2%; odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.57-0.95), as was surgical site infection (2.9% vs 8.1%; OR = 0.45, 95% CI 0.24-0.82). There was no difference in operative time, margin positivity, incidence of postoperative pancreatic fistula, and mortality.
  
  
  CONCLUSIONS
  LDP has lower blood loss and reduced length of hospital stay. There was a lower risk of overall postoperative complications and wound infection, without a substantial increase in the operative time. Although a thorough evaluation of oncological outcomes was not possible, the rate of margin positivity was comparable to the open technique. The improved complication profile of LDP, taken together with the lack of compromise of margin status, suggests that this technique is a reasonable approach in selected cancer patients.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Venkat
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009017:Morbidity; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery