Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies

Introduction The laparoscopic approach to distal pancreatectomy (DP) for benign and malignant diseases appears to offer advantages and is replacing open surgery in some centers. This review examined the evidence from published data of comparative studies of laparoscopic versus open DP. Methods The Medline and PubMed databases were searched and relevant English language publications were systematically retrieved. Data were pooled by two independent reviewers. The results shown represent mean. Results Up to December 2010, 13 comparative studies of laparoscopic versus open DP were identified of which two were excluded, leaving 503 and 588 patients respectively for analysis. The conversion rate was 9.5%. The groups were comparable for age and sex, whilst open surgery was associated with significantly higher incidence of malignant pathology (20.1 vs. 15.0%) and larger tumors (3.9 vs. 3.5 cm) compared with laparoscopic surgery. There were no differences between the two approaches with regard to the operative time (220 vs. 208 min), rate of postoperative pancreatic fistula (16.1 vs. 19.5%), and mortality (0.6 vs. 0.5%). However, the laparoscopic approach was associated with significantly lower operative blood loss (237 vs. 562 ml), higher spleen preservation rate (37.8 vs. 8%), lower morbidity (30.5 vs. 38.4%), and shorter postoperative hospital stay (9.1 vs. 14.7 days). Conclusions The laparoscopic approach to DP offers advantages over open surgery with lower operative morbidity, higher spleen preservation rate, and shorter hospital stay; these benefits are particularly observed in patients with benign disease and borderline malignancy. The experience with laparoscopic DP for malignant disease remains limited, and long-term follow-up data are required to clearly define this role.