Complications following laparoscopic versus open distal pancreatectomy: a meta-analysis / 中华肝胆外科杂志

ABSTRACT

Objective To systematically evaluate the safety of laparoscopic distal pancreatectomy (LDP) compared with open distal pancreatectomy (ODP).Methods Databases including Cochrane library,MEDLINE,EMbase,Google Scholar and Chinese National Knowledge Infrastructure were searched to enroll randomized clinical trials (RCT),controlled clinical trials (CCT) or retrospective case-control studies to compare LDP with ODP.All articles received quality assessment according to the inclusion and exclusion criteria,then the selected indices were analyzed using the Review Manager Version 5.0 software (The Cochrane Collaboration,Oxford,United Kingdom).Results 21 manuscripts with a total of 2 797 patients were enrolled.1 150 patients underwent LDP and the remaining 1 647 patients underwent ODP.In 20 studies (n =2 597),the total postoperative complication rates were 33.90％ for the LDP group versus 46.80％ for the ODP group [RR =0.76,95％ CI(0.69 ～ 0.84),P ＜ 0.01].In 8 studies (n =1 869) there was no significant difference [RR =0.51,95％ CI(0.21 ～ 1.24),P ＞0.05] in the perioperative mortality between LDP (4/703) and ODP (18/1 166).In 20 studies (n =2 757) there was no significant difference [RR =0.89,95％ CI(0.75 ～ 1.06),P ＞ 0.05] in the pancreatic fistula rate between LDP (168/1 132) and ODP (281/1 625).In 11 studies (n =1 840) the wound infection rate of LDP (3.24％) was significantly lower than ODP (10.85％) [RR =0.34,95％ CI(0.23 ～ 0.52),P ＜ 0.01].No significance was found between the two groups in the rates of pulmonary complications,peritoneal infection,urinary tract infection,postoperative bleeding,pseudocyst formation,intestinal obstruction and ascites formation between LDP and ODP.Conclusions When compared with the traditional open procedure,LDP has the advantages of significantlylower rates of postoperative complication and wound infection.There were no significant differences in postoperative mortality,and pancreatic fistula rate between LDP and ODP.This meta-analysis suggests that LDP is a safe and feasible operative method.