| Background: Pancreatic cancer is the common cause of death due to cancer worldwide.The incidence and mortality rateshave been increasing year by year worldwide.Surgicalresection is the bestoption for these patients and the efficacy of conventionalchemoradiotherapy for pancreatic cancer is limited.Minimally invasive distal pancreatectomy(MIDP)has been an effective and safe surgical for treating benign and borderline distal pancreatic tumors comparing open distal pancreatectomy(ODP),but date for pancreatic cancer are still limited.Objective: The purpose of the this study was to carry out a systematic review and meta-analysis comparing minimally invasive distal pancreatectomy(MIDP)with open distal pancreatectomy(ODP)in treatment of pancreatic cancer in order to evaluate the safety and feasibility of MIDP.Methods: We used search strategies to search the Pub Med,Medline,Web of Science and Cochrane libraryuntil June 2017 to identify randomised controlled trialsand non-randomised studies to compare MIDP and ODP for pancreatic cancer.Data were extracted by two reviewers independently.The statistical analysis was carried out using Review Manager Version 5.3(The Nordic Cochrane Centre,Copenhagen,Denmark).The primary endpoint was 3-years and 5-years overall survival(OS),pancreatic fistula,morbidity,resection margin positive(R1)and length of stay(LOS).The secondary endpoints were intra-and postoperative results,the number of lymph node harvested,lymph node positive and recurrence rate,.Results: 13 studies involving 5970 patients(22.1 % minimally invasive and 77.9 % open)were identified and selected for evaluation.Meta-analysis showed that MIDP had higher 3-years OS(risk ratio [RR],1.24;95%confidence interval [CI],1.14-1.35;P<0.00001)and 5-years OS(RR,1.33;95%CI,1.19-1.49;P<0.00001),lower R1 rate(RR,0.72;95%CI,0.60-0.87;P = 0.008),shorter LOS(standardized mean difference [SMD],-0.38;95%CI,-0.47 to-0.29;P < 0.0001),first oral time(SMD,-1.02;95%CI,-1.95 to-0.46;P=0.0004),less estimated blood loss(EBL)(SMD,-0.59;95% CI,-0.82 to-0.3;P<0.00001),lower tansfusion rate(RR,0.39;95% CI,0.28-0.55;P<0.0001),and fewer 90-days mortality(RR,0.49;95%CI,0.26-0.93;P=0.03)compared to ODP.However,the meta-analysis showed that these outcomes of MIDP versus ODP for treatment of pancreatic cancer were comparable in terms of pancreatic fistula,morbidity,operative time,reoperation,30-days readmission,lymph node number harvested,lymph node positive,30-days mortality and recurrence[(RR,0.97;95% CI,0.70-1.33;P=0.83);(RR,0.80;95%CI,0.62-1.03;P=0.09);(SMD,-0.08;95%CI,-0.27 to 0.12;P = 0.45);(RR,0.71;95%CI,0.30-1.70;P=0.45);(RR,0.89;95%CI,0.64-1.24;P=0.49);(SMD,0.48;95%CI,-0.05 to 0.41;P = 0.13);(RR,0.99;95%CI,0.86-1.15;P=0.94);(RR,0.40;95%CI,0.16-1.02;P=0.05);(RR,0.95;95%CI,0.74-1.22;P=0.66)].Conclusion: The meta-analysis showed that these outcomes of MIDP versus ODP for treatment of pancreatic cancer were comparable in terms of pancreatic fistula,morbidity,operative time,reoperation,30-days readmission,lymph node positive,30-days mortality and recurrence.However,this meta-analysis indicates the potential advantage of MIDP in improving the 3-and 5-year OS rates,operative time,estimated blood loss,lymph node number harvested,tansfusion rate,R1 rate,and length of stay. |
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