title: Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis.
abstract: BACKGROUND
  The use of laparoscopic distal pancreatectomy (LDP) increased in the past twenty years but the real diffusion of this technique is still unknown as well as the type of centers (high or low volume) in which this procedure is more frequently performed.
  
  
  METHODS
  A systematic review was performed to evaluate the frequency of LDP in Italy and to compare indications and results in high volume centers (HVCs) and in low volume centers (LVCs).
  
  
  RESULTS
  From 95 potentially relevant citations identified, only 5 studies were included. A total of 125 subjects were analyzed, of whom 95 (76.0%) were from HVCs and 30 (24.0%) from LVCs. The mean number of LDPs performed per year was 6.5. The mean number of patients who underwent LDP per year was 8.8 in HVCs and 3.0 in LVCs (P<0.001). The most frequent lesions operated on in HVCs were cystic tumors (62.1%, P<0.001) while, in LVCs, solid neoplasms (76.7%, P<0.001). In HVCs, malignant neoplasms were treated with LDP less frequently than in LVCs (17.9% vs 50.0%, P<0.001). Splenectomy was performed for non-oncologic reason frequenter in HVCs than in LVCs (70.2% vs 25.0%, P=0.004). The length of stay was shorter in HVCs than in LVCs (7.5 vs 11.3, P<0.001). No differences were found regarding age, gender, ductal adenocarcinoma treated, operative time, conversion, morbidity, postoperative pancreatic fistula, reoperation and margin status.
  
  
  CONCLUSIONS
  LDPs were frequently performed in Italy. The "HVC approach" is characterized by a careful selection of patients undergoing LDP. The "LVC approach" is based on the hypothesis that LDPs are equivalent both in short-term and long-term results to laparotomic approach. These data are not conclusive and they point out the need for a national register of laparoscopic pancreatectomy.
authors.affiliation: Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Universita di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. claudiochir@gmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Enrico
authors.initials: E
authors.lastname: Lazzarini
authors.forename: Marielda
authors.initials: M
authors.lastname: D'Ambra
authors.forename: Salvatore
authors.initials: S
authors.lastname: Buscemi
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Pacilio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Taffurelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
mesh_terms: D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D013156:Splenectomy / Q000706:statistics & numerical data