Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Mar 7;7(2):zrad007.
doi: 10.1093/bjsopen/zrad007.

Minimally invasive versus open pancreatic surgery: meta-analysis of randomized clinical trials

Matthias Pfister  1   2 , Pascal Probst  1 , Philip C Müller  2 , Pia Antony  1 , Rosa Klotz  3 , Eva Kalkum  3 , Daniela Merz  3 , Pietro Renzulli  4 , Fabian Hauswirth  4 , Markus K Muller  1   4
Affiliations
Meta-Analysis

Minimally invasive versus open pancreatic surgery: meta-analysis of randomized clinical trials

Matthias Pfister et al. BJS Open. .

Abstract

Background: Widespread implementation of the minimally invasive technique in pancreatic surgery has proven to be challenging. The aim of this study was to compare the perioperative outcomes of minimally invasive (laparoscopic and robotic) pancreatic surgery with open pancreatic surgery using data obtained from RCTs.

Methods: A literature search was done using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Web of Science; all available RCTs comparing minimally invasive pancreatic surgery and open pancreatic surgery in adults requiring elective distal pancreatectomy or partial pancreatoduodenectomy were included. Outcomes were mortality rate, general and pancreatic surgery specific morbidity rate, and length of hospital stay.

Results: Six RCTs with 984 patients were included; 99.0 per cent (486) of minimally invasive procedures were performed laparoscopically and 1.0 per cent (five) robotically. In minimally invasive pancreatic surgery, length of hospital stay (-1.3 days, -2 to -0.5, P = 0.001) and intraoperative blood loss (-137 ml, -182 to -92, P < 0.001) were reduced. In the subgroup analysis, reduction in length of hospital stay was only present for minimally invasive distal pancreatectomy (-2 days, -2.3 to -1.7, P < 0.001). A minimally invasive approach showed reductions in surgical site infections (OR 0.4, 0.1 to 0.96, P = 0.040) and intraoperative blood loss (-131 ml, -173 to -89, P < 0.001) with a 75 min longer duration of surgery (42 to 108 min, P < 0.001) only in partial pancreatoduodenectomy. No significant differences were found with regards to mortality rate and postoperative complications.

Conclusion: This meta-analysis presents level 1 evidence of reduced length of hospital stay and intraoperative blood loss in minimally invasive pancreatic surgery compared with open pancreatic surgery. Morbidity rate and mortality rate were comparable, but longer duration of surgery in minimally invasive partial pancreatoduodenectomy hints that this technique in partial pancreatoduodenectomy is technically more challenging than in distal pancreatectomy.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
Risk-of-bias assessment
See this image and copyright information in PMC

Comment in

References

    1. Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 2015;15:48. - PMC - PubMed
    1. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 2006;8:CD006231 - PubMed
    1. Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer 2012;3:49–57 - PMC - PubMed
    1. Mariette C, Markar SR, Dabakuyo-Yonli TS, Meunier B, Pezet D, Collet Det al. . Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med 2019;380:152–162 - PubMed
    1. Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JRet al. . Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012;379:1887–1892 - PubMed

Publication types