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Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized controlled trials.
Korrel, Maarten; Vissers, Frederique L; van Hilst, Jony; de Rooij, Thijs; Dijkgraaf, Marcel G; Festen, Sebastiaan; Groot Koerkamp, Bas; Busch, Olivier R; Luyer, Misha D; Sandström, Per; Abu Hilal, Mohammad; Besselink, Marc G; Björnsson, Bergthor.
Afiliación
  • Korrel M; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Vissers FL; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • van Hilst J; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Surgery, OLVG Oost, Amsterdam, the Netherlands.
  • de Rooij T; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Dijkgraaf MG; Clinical Research Unit, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Festen S; Department of Surgery, OLVG Oost, Amsterdam, the Netherlands.
  • Groot Koerkamp B; Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
  • Busch OR; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Luyer MD; Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
  • Sandström P; Department of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
  • Abu Hilal M; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom; Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
  • Besselink MG; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: m.g.besselink@amsterdamumc.nl.
  • Björnsson B; Department of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
HPB (Oxford) ; 23(3): 323-330, 2021 03.
Article en En | MEDLINE | ID: mdl-33250330
BACKGROUND: Minimally invasive distal pancreatectomy (MIDP) has been suggested to reduce postoperative outcomes as compared to open distal pancreatectomy (ODP). Recently, the first randomized controlled trials (RCTs) comparing MIDP to ODP were published. This individual patient data meta-analysis compared outcomes after MIDP versus ODP combining data from both RCTs. METHODS: A systematic literature search was performed to identify RCTs on MIDP vs. ODP, and individual patient data were harmonized. Primary endpoint was the rate of major (Clavien-Dindo ≥ III) complications. Sensitivity analyses were performed in high-risk subgroups. RESULTS: A total of 166 patients from the LEOPARD and LAPOP RCTs were included. The rate of major complications was 21% after MIDP vs. 35% after ODP (adjusted odds ratio 0.54; p = 0.148). MIDP significantly reduced length of hospital stay (6 vs. 8 days, p = 0.036), and delayed gastric emptying (4% vs. 16%, p = 0.049), as compared to ODP. A trend towards higher rates of postoperative pancreatic fistula was observed after MIDP (36% vs. 28%, p = 0.067). Outcomes were comparable in high-risk subgroups. CONCLUSION: This individual patient data meta-analysis showed that MIDP, when performed by trained surgeons, may be regarded as the preferred approach for distal pancreatectomy. Outcomes are improved after MIDP as compared to ODP, without obvious downsides in high-risk subgroups.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Pancreáticas / Laparoscopía Tipo de estudio: Clinical_trials / Etiology_studies / Systematic_reviews Límite: Humans Idioma: En Revista: HPB (Oxford) Asunto de la revista: GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Pancreáticas / Laparoscopía Tipo de estudio: Clinical_trials / Etiology_studies / Systematic_reviews Límite: Humans Idioma: En Revista: HPB (Oxford) Asunto de la revista: GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido