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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies

AC Jusoh and BJ Ammori.

Review published: 2012.

CRD summary

The authors concluded that laparoscopic distal pancreatectomy had advantages over open surgery with lower operative morbidity, higher spleen preservation rate and shorter hospital stay, particularly in patients with benign and borderline malignant pathology. Possible omission of relevant studies, scarcity of information regarding review methods and apparent variation between studies mean that these conclusions may not be reliable.

Authors' objectives

To compare clinical outcomes for laparoscopic versus open distal pancreatectomy.

Searching

PubMed was searched from 1989 to November 2010 for articles published in English. Search terms were reported. Further studies were identified through cross-referencing.

Study selection

Comparative studies of laparoscopic versus open distal pancreatectomy were eligible for inclusion. Abstracts, letters, reviews and non-comparative studies were excluded. Quality-related factors were considered during the full article stage of study selection.

Where reported, mean patient age per study group ranged from 46.7 to 68 years. From 24% to 68.6% of participants were men. Body mass index values at baseline ranged from 21 to 27.9. Clinical outcomes analysed included operative time, estimated blood loss, spleen preservation rate, postoperative hospital stay, rates of morbidity and mortality, postoperative pancreatic fistula rate, need for re-intervention and resected tumour characteristics.

Two reviewers independently selected studies for inclusion.

Assessment of study quality

The authors did not report a formal quality assessment but they reported quality-related factors of randomisation, baseline comparability of study groups, use of intention-to-treat analysis and use of matched pair study designs.

Two reviewers assessed the study factors.

Data extraction

Data were extracted and weighted by sample size to calculate means and standard deviations or medians and ranges.

The authors did not report how many reviewers extracted these data.

Methods of synthesis

A narrative synthesis was presented.

Results of the review

Eleven studies were included in the review (1,091 participants): 10 studies were retrospective (979 patients) and one was prospective (112 patients). Four studies reportedly had matched pair designs. Two studies performed intention-to-treat analyses.

Overall conversion rate from laparoscopic to open surgery was 9.5% (common reasons for conversion were reported). Compared with open surgery, laparoscopic surgery had significantly less operative blood loss (237mL versus 562mL, p<0.001), a higher spleen preservation rate (37.8% versus 8%, p<0.001), lower morbidity (30.5% versus 38.4%, p=0.007), and shorter postoperative hospital stay (9.1 days versus 14.7 days, p<0.001).

Six of the nine studies that investigated the size of resected tumours reported smaller tumours with laparoscopy than with open surgery; only two studies reported this difference as being statistically significant. Most resected tumours were cystic neoplasms or neuroendocrine tumours; no notable differences observed between the two surgical approaches.

No significant differences were found between the two surgery types for operative time, rate of postoperative pancreatic fistula and mortality. Other results (use of postoperative analgesia, return of bowel function and return to normal activity) were reported in the paper.

Cost information

Mixed results were found in relation to hospital cost differences for laparoscopic resection and open surgery in two studies (results reported fully in paper).

Authors' conclusions

Laparoscopic distal pancreatectomy had advantages over open surgery due to lower operative morbidity, higher spleen preservation rate and shorter hospital stay. These benefits were particularly observed in patients with benign and borderline malignant pathology.

CRD commentary

The review question was clear. Inclusion criteria were sufficiently reproducible in relation to intervention, comparator, study design and outcomes. There was a possibility that relevant studies were missed as only one database was searched and the search was restricted to publications in English. Little information on review methods was reported which made it difficult to assess the likelihood of reviewer error and bias. No standardised criteria were used to assess study quality but quality-related factors were considered; one study was reportedly excluded because of insufficient baseline comparability between the laparoscopic and open surgery groups. Study details were presented but detail was lacking on population characteristics.

The methods of synthesis seemed appropriate but the unclear or varied nature of most outcome definitions suggested that between-study heterogeneity may have been substantial.

Possible omission of relevant studies, scarcity of information concerning review methods and unknown levels of between-study heterogeneity mean that the authors' conclusions may not be reliable.

Implications of the review for practice and research

Practice: The authors stated that institutions with expertise in the laparoscopic approach should consider it the gold standard for patients with benign and borderline malignant pathology.

Research: The authors stated that long-term oncologic follow-up data were required to clearly define the role of laparoscopic distal pancreatectomy for malignant disease.

Funding

Not stated.

Bibliographic details

Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surgical Endoscopy 2012; 26(4): 904-913. [PubMed: 22083328]

Indexing Status

Subject indexing assigned by NLM

MeSH

Analgesics /therapeutic use; Blood Loss, Surgical /statistics & numerical data; Costs and Cost Analysis; Humans; Laparoscopy /methods; Length of Stay; Organ Sparing Treatments /methods; Pancreatectomy /methods; Pancreatic Fistula /etiology; Pancreatic Neoplasms /surgery; Postoperative Care /methods; Postoperative Complications /etiology; Prospective Studies; Retrospective Studies; Treatment Outcome

AccessionNumber

12012031645

Database entry date

19/02/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 22083328

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