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Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized
Maarten Korrel1, Frederique L Vissers1, Jony van Hilst2
1Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
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.
Insights
Minimally invasive distal pancreatectomy (MIDP) shows improved outcomes compared to open distal pancreatectomy (ODP). This meta-analysis found MIDP reduced hospital stay and delayed gastric emptying, suggesting it as a preferred approach.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Minimally invasive distal pancreatectomy (MIDP) is hypothesized to offer better postoperative outcomes than open distal pancreatectomy (ODP).
- Recent randomized controlled trials (RCTs) have directly compared MIDP and ODP.
- This study presents an individual patient data meta-analysis of these RCTs.
Purpose of the Study:
- To compare the postoperative outcomes of MIDP versus ODP.
- To evaluate complication rates, hospital stay, and specific postoperative morbidities.
- To assess the safety and efficacy of MIDP in high-risk patient subgroups.
Main Methods:
- A systematic literature search identified relevant RCTs comparing MIDP and ODP.
- Individual patient data from identified RCTs were harmonized for analysis.
- The primary endpoint was the rate of major complications (Clavien-Dindo ≥ III), with sensitivity analyses in high-risk groups.
Main Results:
- The analysis included 166 patients from the LEOPARD and LAPOP RCTs.
- Major complication rates were 21% for MIDP versus 35% for ODP (aOR 0.54, p=0.148).
- MIDP significantly reduced hospital stay (6 vs. 8 days, p=0.036) and delayed gastric emptying (4% vs. 16%, p=0.049).
- A trend towards higher postoperative pancreatic fistula rates was noted after MIDP (36% vs. 28%, p=0.067).
- Outcomes remained comparable between MIDP and ODP in high-risk subgroups.
Conclusions:
- Minimally invasive distal pancreatectomy (MIDP) may be the preferred surgical approach for distal pancreatectomy when performed by experienced surgeons.
- MIDP demonstrates improved outcomes compared to ODP, with no significant increased risks in high-risk populations.
- The findings support the adoption of MIDP for selected patients undergoing distal pancreatectomy.
