83 - Freie Mitteilung
3. Juni 2022, 08:30 - 10:00, Szenario 2
Minimally-Invasive Pancreatic Enucleation (MI-pEn): Systematic Review and PRISMA Compliant Metanalysis of short-term outcomes compared to open surgery.
R. Roesel1, L. Bernardi2, P. E. Majno-Hurst2, A. Cristaudi2, Presenter: L. Bernardi2 (1Geneva, 2Lugano)
Minimally Invasive Pancreatic Enucleation, either laparoscopic or robot-assisted, is rarely performed. The aim of this study was to evaluate the published evidence for its short-term outcomes in comparison to standard open surgery.
PubMed (MEDLINE), Cochrane Library and Scopus (ELSEVIER) databases were searched for articles published from January 1990 to August 2021. Studies which included more than 10 cases of minimally-invasive pancreatic enucleation were included. Data on the outcomes were synthetized and meta-analyzed when appropriate.
Thirty-one studies involving 1740 patients were included in the systematic review, 799 patients (45.9%) underwent pancreatic enucleation with minimally invasive approach with 10% conversion rate. Surgery was performed in 63.5% of cases on the body/tail of the gland. The cumulative postoperative mortality was 0.13% and the major postoperative morbidity (Clavien-Dindo III-IV-V) 50.3%. Clinically relevant pancreatic fistula was observed in 17% of the patients. Eight studies with a total of 626 patients were included in the metanalysis. Compared with the standardized open approach, mean length of hospital stay was significantly reduced in patients undergoing minimally invasive pancreatic enucleation of 2.32 days (95% CI: -3.80 / -0.96; p = 0.001; I2=50%). Operative time, blood loss, major post-operative morbidity and clinically relevant pancreatic fistula rate were comparable between the two groups. One hundred and fourteen robot-assisted enucleations (performed in 54% of cases on pancreatic head/uncus), entered in a subgroup analysis with comparable results to open surgery.
Minimally-Invasive approach for pancreatic enucleation is feasible and reduces time to functional recovery compared with open surgery without increasing the risk of major complications, particularly clinically relevant pancreatic fistulas.