Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma: a systematic review and meta-analysis.

OBJECTIVES To compare the effectiveness, safety and oncologic adequacy of laparoscopic and open distal pancreatectomy (ODP) for pancreatic adenocarcinoma. METHODS A systematic literature search was performed using EMBASE, Medline, the Cochrane library, and Google Scholar. Meta-analyses were performed using both fixed-effect and random-effect models. A cumulative meta-analysis was performed to track the accumulation of evidence. The power that a new trial of specified samples would give to the present meta-analysis was estimated with simulation-based sample size calculation. RESULTS Patients who underwent laparoscopic distal pancreatectomy (LDP) had significantly smaller tumours [mean difference (MD) = -0.49 (-0.83 to -0.14), p = 0.005], less estimated blood loss [MD = -157.27 (-281.63 to -32.91), p = 0.01], and shorter average hospital stay by two days [MD = -2.35 (-3.1 to -1.59), p < .001] than those who underwent ODP. No significant differences in feasibility, effectiveness, and safety were noted. Cumulative meta-analysis demonstrated that the results were not dominated by a particular study. A new trial with 350 patients in each arm will give a maximum power of 48% to the present meta-analysis. CONCLUSIONS LDP for pancreatic adenocarcinoma provides similar clinical and oncologic outcomes with shorter hospital stay by two days compared to ODP. However, underpowered sample size and smaller tumour size may have influenced the results of laparoscopic surgery. Therefore, an adequately powered randomized controlled trial is needed to shed further light on the appropriateness of this approach.