Minimally invasive pancreatectomy provides better outcomes against low-grade tumors

France: In a new study conducted by Sara Sentí Farrarons and team, it was found that, for benign and low-grade malignant tumors of the neck and torso, minimally invasive central pancreatectomy provides a safe alternative to open central pancreatectomy in the hands of skilled surgeons. The findings of this study were published in Surgery.

With a focus on the postoperative pancreatic fistula, this systematic review and meta-analysis aim to provide an overview of the postoperative outcome following minimally invasive (i.e., laparoscopic and robot-assisted) central pancreatectomy and open central pancreatectomy. Central pancreatectomy may be a better option than distal pancreatectomy for benign and low-grade malignant tumors in the pancreatic neck and body. After central pancreatectomy, exocrine and endocrine dysfunction occur less frequently, although postoperative pancreatic fistula are more common.

An electronic search was conducted in PubMed, Cochrane Register, Embase, and Google Scholar for articles on elective minimally invasive central pancreatectomy and open central pancreatectomy that reported on significant morbidity and postoperative pancreatic fistula through June 1, 2021. Prior to the review, a review procedure was created and registered in PROSPERO as CRD42021259738. A random effects model was employed to conduct a meta-regression.

The key highlights of this study were:

1. In all, 41 trials involving 1,004 patients were considered, with 158 laparoscopic minimally invasive central pancreatectomies, 80 robot-assisted minimally invasive central pancreatectomies, and 766 open central pancreatectomies performed.

2. The total rate of postoperative pancreatic fistula was 14%, with 14% experiencing significant morbidity and 1% dying within 30 days.

3. The incidence of postoperative pancreatic fistula, severe morbidity, and new-onset diabetes were not substantially different between minimally invasive and open central pancreatectomy.

4. When compared to open central pancreatectomy, minimally invasive central pancreatectomy was linked with considerably fewer blood transfusions, less exocrine pancreatic insufficiency, and fewer readmissions.

5. Minimally invasive central pancreatectomy and open central pancreatectomy were compared using a meta-regression using a random effects model, and there was no discernible difference in postoperative pancreatic fistula, serious morbidity, or new-onset diabetes mellitus.

In conclusion, the findings of this study should ideally be confirmed by additional study, with a particular emphasis on postoperative pancreatic fistula and endocrine and exocrine insufficiency.

Reference: 

Farrarons, S. S., van Bodegraven, E. A., Sauvanet, A., Hilal, M. A., Besselink, M. G., & Dokmak, S. (2022). Minimally invasive versus open central pancreatectomy: Systematic review and meta-analysis. In Surgery. Elsevier BV. https://doi.org/10.1016/j.surg.2022.06.024