Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure?

OBJECTIVES Distal pancreatectomies and enucleations have become the most popular laparoscopic pancreatic resections and in some centers outnumber the traditional open approach. The aim of this study was to systematically review the literature on the safety of laparoscopic distal pancreatectomies (LDP) in relation to open distal pancreatectomies in the management of adult patients and, where possible, perform a meta-analysis of reported outcomes. METHODS We searched MEDLINE, EMBASE, Web of knowledge, and the Cochrane Database of Systematic Reviews using the following keywords: pancreas, pancreatectomy, pancreatic, laparoscopic, laparoscopy. Publication dates and language restrictions were applied. The Newcastle Ottawa scale was used for study quality assessment. RESULTS Four eligible studies were identified with a total of 665 patients. On average, LDPs had a longer operation time by 17.7 minutes (9.5%) and a reduced hospital stay by 2.7 days. Morbidity and mortality were low using both approaches. CONCLUSIONS This study represents the strongest evidence (level 3a) to date that LDPs are a safe operation. However, there is still a need for randomized controlled trials to confirm this.