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      Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD) : A Multicenter Patient-blinded Randomized Controlled Trial

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          Abstract

          This trial followed a structured nationwide training program in minimally invasive distal pancreatectomy (MIDP), according to the IDEAL framework for surgical innovation, and aimed to compare time to functional recovery after minimally invasive and open distal pancreatectomy (ODP).

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          Most cited references26

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          Randomised trials in surgery: problems and possible solutions.

          Damian Griffin, Paris B. Lovett, Mitsuru Sasako … (2002)
          Article 0 comments Cited 172 times – based on 0 reviews     Review now
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            Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours

            C Palanivelu, P Senthilnathan, S. Sabnis … (2017)
            Laparoscopic resection as an alternative to open pancreatoduodenectomy may yield short-term benefits, but has not been investigated in a randomized trial. The aim of this study was to compare laparoscopic and open pancreatoduodenectomy for short-term outcomes in a randomized trial.
            Article 0 comments Cited 119 times – based on 0 reviews     Review now
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              Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis.

              Martin Makary, Christopher L. Wolfgang, Raghunandan Venkat … (2012)
              To compare laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) by using meta-analytical techniques. LDP is increasingly performed as an alternative approach for distal pancreatectomy in selected patients. Multiple studies have tried to assess the safety and efficacy of LDP compared with ODP. A systematic review of the literature was performed to identify studies comparing LDP and ODP. Intraoperative outcomes, postoperative recovery, oncologic safety, and postoperative complications were evaluated. Meta-analysis was performed using a random-effects model. Eighteen studies matched the selection criteria, including 1814 patients (43% laparoscopic, 57% open). LDP had lower blood loss by 355 mL (P < 0.001) and hospital length of stay by 4.0 days (P < 0.001). Overall complications were significantly lower in the laparoscopic group (33.9% vs 44.2%; odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.57-0.95), as was surgical site infection (2.9% vs 8.1%; OR = 0.45, 95% CI 0.24-0.82). There was no difference in operative time, margin positivity, incidence of postoperative pancreatic fistula, and mortality. LDP has lower blood loss and reduced length of hospital stay. There was a lower risk of overall postoperative complications and wound infection, without a substantial increase in the operative time. Although a thorough evaluation of oncological outcomes was not possible, the rate of margin positivity was comparable to the open technique. The improved complication profile of LDP, taken together with the lack of compromise of margin status, suggests that this technique is a reasonable approach in selected cancer patients.
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                Author and article information

                Journal
                Title: Annals of Surgery
                Abbreviated Title: Annals of Surgery
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0003-4932
                Publication date Created: 2019
                Publication date (Print): January 2019
                Volume: 269
                Issue: 1
                Pages: 2-9
                Article
                DOI: 10.1097/SLA.0000000000002979
                PubMed ID: 30080726
                SO-VID: 09a7f321-750c-4300-86c1-df68a2942a43
                Copyright © © 2019
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