TY - JOUR
T1 - Minimally invasive versus open distal pancreatectomy
T2 - an individual patient data meta-analysis of two randomized controlled trials
AU - for the International Minimally Invasive Pancreatic Resection Trialists Group
AU - Korrel, Maarten
AU - Vissers, Frederique L.
AU - van Hilst, Jony
AU - de Rooij, Thijs
AU - Dijkgraaf, Marcel G.
AU - Festen, Sebastiaan
AU - Groot Koerkamp, Bas
AU - Busch, Olivier R.
AU - Luyer, Misha D.
AU - Sandström, Per
AU - Abu Hilal, Mohammad
AU - Besselink, Marc G.
AU - Björnsson, Bergthor
N1 - Publisher Copyright:
© 2020 The Author(s)
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85097066521&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2020.10.022
DO - 10.1016/j.hpb.2020.10.022
M3 - Review article
C2 - 33250330
AN - SCOPUS:85097066521
SN - 1365-182X
VL - 23
SP - 323
EP - 330
JO - HPB
JF - HPB
IS - 3
ER -