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      Laparoscopic Distal Pancreatectomy for Cancer Provides Oncologic Outcomes and Overall Survival Identical to Open Distal Pancreatectomy

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          Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer.

          To assess the impact of postoperative complications on the receipt of adjuvant chemotherapy.
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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.

            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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              Comparison of Commission on Cancer–Approved and –Nonapproved Hospitals in the United States: Implications for Studies That Use the National Cancer Data Base

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                Author and article information

                Journal
                Journal of Gastrointestinal Surgery
                J Gastrointest Surg
                Springer Nature
                1091-255X
                1873-4626
                October 2017
                August 1 2017
                October 2017
                : 21
                : 10
                : 1620-1625
                Article
                10.1007/s11605-017-3506-y
                28766272
                5181e256-f3ad-427b-ac1a-f329f0977d28
                © 2017

                http://www.springer.com/tdm

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