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Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized controlled trials

Korrel, Maarten (author)
Univ Amsterdam, Netherlands
Vissers, Frederique L. (author)
Univ Amsterdam, Netherlands
van Hilst, Jony (author)
Univ Amsterdam, Netherlands; OLVG Oost, Netherlands
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de Rooij, Thijs (author)
Univ Amsterdam, Netherlands
Dijkgraaf, Marcel G. (author)
Univ Amsterdam, Netherlands
Festen, Sebastiaan (author)
OLVG Oost, Netherlands
Koerkamp, Bas Groot (author)
Erasmus Univ, Netherlands
Busch, Olivier R. (author)
Univ Amsterdam, Netherlands
Luyer, Misha D. (author)
Catharina Hosp, Netherlands
Sandström, Per A, 1965- (author)
Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
Abu Hilal, Mohammad (author)
Southampton Univ Hosp NHS Fdn Trust, England; Inst Osped Fdn Poliambulanza, Italy
Besselink, Marc G. (author)
Univ Amsterdam, Netherlands
Björnsson, Bergthor, 1975- (author)
Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
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 (creator_code:org_t)
ELSEVIER SCI LTD, 2021
2021
English.
In: HPB. - : ELSEVIER SCI LTD. - 1365-182X .- 1477-2574. ; 23:3, s. 323-330
Related links:
http://www.hpbonline...
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https://urn.kb.se/re...
https://doi.org/10.1...
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  • Research review (peer-reviewed)
Abstract Subject headings
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  • Background: Minimally invasive distal pancreatectomy (MIDP) has been suggested to reduce postoperative outcomes as compared to open distal pancreatectomy (ODP). Recently, the first randomized controlled trials (RCTs) comparing MIDP to ODP were published. This individual patient data meta analysis compared outcomes after MIDP versus ODP combining data from both RCTs. Methods: A systematic literature search was performed to identify RCTs on MIDP vs. ODP, and individual patient data were harmonized. Primary endpoint was the rate of major (Clavien-Dindo > III) complications. Sensitivity analyses were performed in high-risk subgroups. Results: A total of 166 patients from the LEOPARD and LAPOP RCTs were included. The rate of major complications was 21% after MIDP vs. 35% after ODP (adjusted odds ratio 0.54; p = 0.148). MIDP significantly reduced length of hospital stay (6 vs. 8 days, p = 0.036), and delayed gastric emptying (4% vs. 16%, p = 0.049), as compared to ODP. A trend towards higher rates of postoperative pancreatic fistula was observed after MIDP (36% vs. 28%, p = 0.067). Outcomes were comparable in high-risk subgroups. Conclusion: This individual patient data meta-analysis showed that MIDP, when performed by trained surgeons, may be regarded as the preferred approach for distal pancreatectomy. Outcomes are improved after MIDP as compared to ODP, without obvious downsides in high-risk subgroups.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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