Article
Clinical Outcomes of Laparoscopic versus Open Approach for Distal Pancreatic Resection: A Systematic Review
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Published: | April 26, 2013 |
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Introduction: Laparoscopic distal pancreatic resection (LDPR) has had significant development during recent years and is used increasingly in surgical treatment of pancreatic diseases. Since there are few Randomized Clinical Trials and actual comparative data between open and laparoscopic distal pancreatectomy, to overcome these limitations, in this article based on the review of the literature, outcomes of laparoscopic and open pancreatic resection has been compared.
Material and methods: Almost all published papers (n=119) containing case controls or case series from 1990-2011, which reported patients who underwent either laparoscopic or open distal pancreatectomy, were reviewed and analyzed. The investigated parameters included: demographic parameters, pathological diagnosis, operation time, duration of hospital stay as well as intra- and postoperative complications and mortality.
Results: From 10865 reported cases, 74% underwent open approach and 26% were operated with laparoscopy. Intra- and postoperative data showed a lower operation time (214 vs. 233 min), blood loss (331 vs. 629 ml) and overall complication rate (40.6% vs. 46.3%) as well as shorter hospitalization (8 vs. 13 days) in LDPR in comparison to open procedure. However, the fistula formation rate was higher in LDPR group. Furthermore, the overall mortality rate was 1.4% and 0.6% in open and laparoscopic approach, respectively.
Conclusion: LDPR can be considered as a feasible, safe and relatively fast procedure with shorter hospitalization and better postoperative recovery. Nevertheless, due to some challenges and limitations, e. g. in malignant lesions, it is very difficult to recommend it as an optimal procedure. However, it can be a good option in selected patients and in high volume case load and experienced laparoscopic centres.