Laparoscopic versus open distal pancreatectomy: A meta-analysis
Laparoscopic versus open distal pancreatectomy: A meta-analysis
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DOI：
10.1016/j.asjsur.2012.04.001
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发表时间：
2012-01-01
影响因子：
3.5
通讯作者：
Zhou, Yan-Ming
中科院分区：
文献类型：
--
作者：
Sui, Cheng-Jun;Li, Bin;Zhou, Yan-Ming
目的：腹腔镜胰体尾切除术（LDP）是一种微创外科技术。本研究的目的是评估目前可用的文献，并进行比较的短期临床结果的患者接受LDP左侧胰腺病理学与患者接受传统的开放surgery.Methods：进行文献检索，以确定和比较研究，报告的临床结果LDP和开放式远端胰腺切除术（ODP）。合并优势比（OR）和加权平均差异（WMD）与95%的置信区间（95%CI）计算使用固定效应或随机效应models.Results：19非随机对照研究，确定匹配的选择标准，并报告了1935例患者的临床结局，其中805接受LDP和1130接受ODP。与开放手术相比，腹腔镜切除术的报告表明，在手术失血方面可能具有良好的结局（WMD：-273.11; 95% CI：-404.61至-141.61），需要输血（OR：0.28; 95% CI：0.11 - 0.71），术后至经口进食的时间（WMD：-1.19; 95% CI：-1.87至-0.50），至首次排气时间（WMD：-1.03，95%CI：-1.93 ~-0.12）、住院时间（WMD：-3.87，95%CI：-5.06 ~-2.68）和总体发病率（OR：0.70，95%CI：0.56-0.87）。有肿瘤清除和术后mortals.Conclusion的程度方面没有差异：LDP的结果在更快的术后恢复和可比的肿瘤清除与开放手术相比。需要额外的大型试验来描述接受这两种手术之一的恶性肿瘤患者的长期临床结局。版权所有（C）2012，亚洲外科协会。出版社：Elsevier Taiwan LLC All rights reserved.
Objective: Laparoscopic distal pancreatectomy (LDP) is a minimally invasive surgical technique. The aim of the present study was to evaluate the currently available literature and compare the short-term clinical outcomes of patients who underwent LDP for left-sided pancreatic pathology with patients who underwent traditional open surgery.Methods: A literature search was performed to identify and compare studies that reported the clinical outcomes of both LDP and open distal pancreatectomy (ODP). Pooled odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (95% Cl) were calculated using either fixed-effects or random-effects models.Results: Nineteen nonrandomized controlled studies were identified that matched the selection criteria and reported the clinical outcomes of 1935 patients, of whom 805 underwent LDP and 1130 underwent ODP. Compared with open surgery, reports on laparoscopic resection indicate potentially favorable outcomes in terms of operative blood loss (WMD: -273.11; 95% CI: -404.61 to -141.61), the requirement of a blood transfusion (OR: 0.28; 95% CI: 0.11 -0.71), postoperative time until oral intake (WMD: -1.19; 95% CI: -1.87 to -0.50), time to first flatus (WMD: -1.03, 95% CI: -1.93 to -0.12), length of hospital stay (WMD: -3.87, 95% CI: -5.06 to -2.68), and overall morbidity (OR: 0.70, 95% CI: 0.56-0.87). There were no differences in terms of the extent of oncologic clearance and postoperative mortality.Conclusion: LDP results in a faster postoperative recovery and a comparable oncologic clearance in comparison with open surgery. Additional large trials are required to delineate the long-term clinical outcomes of patients diagnosed with malignant neoplasms who undergo either of these two surgeries. Copyright (C) 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.