Minimally invasive versus open distal pancreatectomy for pancreatic Tumors: An updated meta-analysis and meta-regression.

Abstract

This study aims to compare the efficacy and safety of minimally invasive distal pancreatectomy (MIDP) and open distal pancreatectomy (ODP) for pancreatic neoplasms. A meta-analysis following PRISMA guidelines, registered on PROSPERO, included randomized controlled trials (RCTs) and propensity-score matched studies. Data from Cochrane Central, PubMed, and Embase were analyzed, focusing on procedure efficacy (e.g., length of hospital stay and reoperations), oncologic outcomes (e.g., R0 resections), surgical outcomes (e.g., blood loss and operative time), and postoperative outcomes (e.g., 90-day mortality, severe complications, pancreatic fistula). Among 23 studies, MIDP showed significantly reduced 90-day mortality (OR: 0.57, p = 0.03), severe (CDC ≥ III) complications (OR: 0.81, p = 0.04), hospital stay (MD: 2.38 days, p < 0.01), reoperations (OR: 0.65, p < 0.01) and blood loss (MD: 137.66 mL, p < 0.01) compared to ODP. No significant differences were found in postoperative pancreatic fistula (OR: 1.06, p = 0.74) or operative time (MD: 1.95 min, p = 0.87). ODP showed a significantly lower incidence of R0 resections (OR: 1.57, p < 0.01). Subgroup analyses of RCTs favored MIDP for 90-day mortality, severe complications, and hospital stay, but found no differences in pancreatic fistula or operative time. Meta-regression identified age and tumor size as influential covariates. MIDP offers superior outcomes in procedure efficacy, surgical and postoperative outcomes compared to ODP. These findings highlight MIDP as a safe and effective alternative for pancreatic surgery, supported by robust subgroup and sensitivity analyses.