title: Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery.
abstract: Postoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically determine the pooled incidence of pancreatic events following radical gastrectomy. We also aimed to elucidate whether any difference in incidence exists between patients operated via conventional open or minimally invasive surgery.
  
  
  
  PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized or well-matched studies comparing conventional with minimally invasive oncological gastrectomy and reporting pancreas-related postoperative complications. We evaluated possible differences in outcomes between open and minimally invasive surgery. A meta-analysis of relevant comparisons was performed using RevMan 5.3.
  
  
  
  A total of 20 studies, whereby 6 randomized and 14 non-randomized comparative studies including a total of 7336 patients, were considered eligible for data extraction. Globally, more than 1% of patients experienced some pancreatic occurrences during the postoperative course. The use of minimally invasive surgery showed a trend toward increased overall pancreatic morbidity (OR 1.39), pancreatitis (OR 2.69), and pancreatic fistula (OR 1.13).
  
  
  
  Although minimally invasive radical gastrectomy is currently established as a valid alternative to open surgery for the treatment of gastric cancer, a higher risk of pancreas-related morbidity should be taken into account.
authors.affiliation: Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy. fra.guerra.mail@gmail.com.
authors.forename: Francesco
authors.identifier: 0000-0003-2891-4659
authors.initials: F
authors.lastname: Guerra
authors.affiliation: Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giuliani
authors.affiliation: Division of General Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Iacobone
authors.affiliation: Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy.
authors.forename: Paolo Pietro
authors.initials: PP
authors.lastname: Bianchi
authors.affiliation: Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Coratti
mesh_terms: D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D010179:Pancreas / Q000473:pathology; D010182:Pancreatic Diseases / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Gastrectomy; Gastric cancer; Minimally invasive surgery; Pancreatic fistula; Pancreatitis