title: Is laparoscopic approach for pancreatic insulinomas safe? Results of a systematic review and meta-analysis.
abstract: BACKGROUND
  No consensus exists as to whether laparoscopic treatment for pancreatic insulinomas (PIs) is safe and feasible. The aim of this meta-analysis was to assess the feasibility, safety, and potential benefits of laparoscopic approach (LA) for PIs. The abovementioned approach is also compared with open surgery.
  
  
  METHODS
  A systematic literature search (MEDLINE, EMBASE, Cochrane Library, Science Citation Index, and Ovid journals) was performed to identify relevant articles. Articles that compare the use of LA and open approach to treat PI published on or before April 30, 2013, were included in the meta-analysis. The evaluated end points were operative outcomes, postoperative recovery, and postoperative complications.
  
  
  RESULTS
  Seven observational clinical studies that recruited a total of 452 patients were included. The rates of conversion from LA to open surgery ranged from 0%-41.3%. The meta-analysis revealed that LA for PIs is associated with reduced length of hospital stay (weighted mean difference, -5.64; 95% confidence interval [CI], -7.11 to -4.16; P < 0.00001). No significant difference was observed between LA and open surgery in terms of operation time (weighted mean difference, 2.57; 95% CI, -10.91 to 16.05; P = 0.71), postoperative mortality, overall morbidity (odds ratio [OR], 0.64; 95% CI, 0.35-1.17; P = 0.14], incidence of pancreatic fistula (OR, 0.86; 95% CI, 0.51-1.44; P = 0.56), and recurrence of hyperglycemia (OR, 1.81; 95% CI, 0.41-7.95; P = 0.43).
  
  
  CONCLUSIONS
  Laparoscopic treatment for PIs is a safe and feasible approach associated with reduction in length of hospital stay and comparable rates of postoperative complications in relation with open surgery.
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: An-Ping
authors.initials: AP
authors.lastname: Su
authors.forename: Neng-Wen
authors.initials: NW
authors.lastname: Ke
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xu-Bao
authors.initials: XB
authors.lastname: Liu
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Hu
authors.forename: Bo-Le
authors.initials: BL
authors.lastname: Tian
authors.forename: Zhao-Da
authors.initials: ZD
authors.lastname: Zhang
mesh_terms: D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007340:Insulinoma / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000601:surgery*
keywords: Laparoscopy; Open surgery; Pancreatic fistula; Pancreatic insulinoma