Spleen-preserving distal pancreatectomy from multi-port to reduced-port surgery approach

Table 1 Included studies listed according to year of publication

Study No.	Ref.	Period	Type of surgery	No. of trocars	M/F	Age
1	Yao et al[14], 2014	2009-2013	RP_LDP	1	0/11	38 ± 14.5
2	Han et al [15], 2014	2007-2013	MP_LDP	-	11/17	49.1 ± 15.81
			RP_LDP	1	2/10	61.3 ± 17.21
3	Machado et al[16], 2015	2012-2014	RP_LDP	1	8/12	44.6 ± 13.4
4	Kim et al[17], 2017	2015-2016	RDP_SS+1	2	2/3	37 ± 14.7
5	Sumer et al[18], 2017	2006-2013	MP_LDP	4	7/20	49.5 ± 14.9
			RP_LDP	1	0/3	54.3 ± 13.6
6	Ağcaoğlu et al[19], 2019	2007-2014	MP_LDP	5	3/7	48.2 ± 4.0
			RP_LDP	1	4/6	43.5 ± 2.3
7	Park et al[20], 2019	2012-2017	MP_LDP	4.4 ± 0.8	31/44	55.3 ± 14
			MP_LDP (propensity score matched)	4.3 ± 0.5	9/17	55.2 ± 15.3
			RP_LDP	1	9/17	60.0 ± 17.4
8	Kim et al[21], 2019	2015-2018	MP_LDP	4.9 ± 0.3	8/18	55.3 ± 15.1
			RP_LDP	2.7 ± 0.7	5/17	51.5 ± 17
9	Han et al[22], 2019	2012-2018	RP_LDP	1.1 ± 0.2	8/14	58.3 ± 15.01
			RDP_SS+1	2.0 ± 0.7	3/10	46.1 ± 14.01
10	Park et al[23], 2020	2015-2018	RDP_SS+1	2	5/22	47.3

¹Significantly different in the original study.

The number of trocars and age are presented as mean ± SD; Sex is reported as number of patients. Propensity score matched between single-port laparoscopic distal pancreatectomy (LDP) and multi-port LDP cohorts. “-” indicates data not available. MP_LDP: Multi-port laparoscopic distal pancreatectomy; RP_LDP: Reduced-port laparoscopic distal pancreatectomy; RDP_SS+1: Robotic distal pancreatectomy with single-site plus one-port.

Table 2 Included studies listed by type of surgery

Type	Study No.	BMI	OP time (min)	Blood loss (mL)	Tumor size (cm)	SP rate (%)	Complication rate (%)		Hospital stay (d)	Follow-up duration (mo)	Ref.
							POPF	Others
MP_LDP	2	23.6 ± 4.0	186.9 ± 86.61	334 ± 468	3.4 ± 2.5	60.7	21.4	25	8.3 ± 4.71	-	[15]
	5	-	163.3 ± 53.7	-	-	48.1	22.2	14.8	9.3 ± 6.6	30 ± 22.3	[18]
	6	31.2 ± 2.4	116.4 ± 14.11	110 (25-250)	2.8 ± 0.6	50	30	10	10	56	[19]
	7	25.4 ± 4.3	182.6 ± 64.41	210 ± 384	3.1 ± 1.9	53.8	20	41.9	13.2 ± 9.4	27.4 ± 22.3	[20]
	7 (propensity score matched)	22.9 ± 2.9	178.7 ± 66.61	114 ± 1811	2.7 ± 2.3	56	11.5	36	11.6 ± 8.8	30.6 ± 24.7	[20]
	8	24.7 ± 2.6	190.9 ± 43.71	282.7 ± 305.31	3.6 ± 2.1	65.4	-	-	8.0 ± 1.4	-	[21]
RP_LDP	1	22.67 ± 1.9	163.18 ± 63.18	159.09 ± 181.02	3.85 ± 1.26	54.5	9.1	0	7.45 ± 1.44	25.8 ± 18.1	[14]
	2	23.5 ± 4.6	279.8 ± 53.01	185 ± 125	3.8 ± 1.8	33.3	25	41.6	12.2 ± 5.41	-	[15]
	3	-	176.2 ± 59.6	77.5 ± 55.0	3.2	90	20	0	2.1 ± 1.2	11	[16]
	5	-	216.7 ± 100.2	-	-	0	66.6	33.3	13 ± 14.9	13 ± 1.7	[18]
	6	29.4 ± 3.1	180.4 ± 34.51	142 (30-500)	2.2 ± 0.2	10	30	20	8	48	[19]
	7	23.6 ± 3.4	278.9 ± 51.81	205 ± 1971	3.3 ± 2.0	46.2	23.1	42.3	15.2 ± 11.4	20.8 ± 16.6	[20]
	8	25.2 ± 4.5	119.3 ± 50.41	96.8 ± 165.31	2.7 ± 1.8	95.5	-	-	7.7 ± 1.3	-	[21]
	9	23.9 ± 3.6	281 ± 521	163 ± 1971	3.0 ± 1.8	54.5	18.2	36.4	14.4 ± 12.31	23.4 ± 18.61	[22]
RDP_SS+1	4	-	203 ± 73.3	11 ± 21.9	-	40	0	-	6.8 ± 1.3	-	[17]
	9	20.9 ± 4.0	192 ± 691	12 ± 221	2.7 ± 1.2	7.7	0	38.5	7.4 ± 1.91	7.8 ± 7.11	[22]
	10	22.6	173	50	3	34.6	23	3.8	7	-	[23]

¹Significantly different in the original study.

Body mass index, operating time (min), blood loss (mL), tumor size (cm), length of hospital stay (d), and length of follow-up (mo) are reported as mean ± SD; spleen preservation rate, postoperative pancreatic fistula rate, and complication rate are reported as percentages. Propensity score matched between single-port laparoscopic distal pancreatectomy (LDP) and multi-port LDP cohorts. “-“ indicates data not available. MP_LDP: Multi-port laparoscopic distal pancreatectomy; RP_LDP: Reduced-port laparoscopic distal pancreatectomy; RDP_SS+1: Robotic distal pancreatectomy with single-site plus one-port; BMI: Body mass index; OP: Operating; POPF: Postoperative pancreatic fistula; SP: Spleen preservation.

Table 3 Postoperative pain scores (only reported in five of the ten studies included)

Type	Study No.	Trocar No.	Postoperative pain score					Ref.
			6 h	Day 1	Day 2	Day 3	Day 5
MP_LDP	6	5	4.5 ± 0.41	1.5 ± 0.5				[19]
	7	4.4 ± 0.8		3.4 ± 1.11	3.4 ± 1.11	3.1 ± 0.91		[20]
	7 (propensity score matched)	4.3 ± 0.5		3.5 ± 0.91	3.3 ± 0.91	3.0 ± 0.91		[20]
	8	4.9 ± 0.3		3.2 ± 1.4		3.5 ± 1.8	2.6 ± 1.31	[21]
RP_LDP	6	1	2.5 ± 0.31	1 ± 0.2				[19]
	7	1		2.7 ± 0.81	2.5 ± 1.31	2.4 ± 1.41		[20]
	8	2.7 ± 0.7		3.1 ± 1.1		2.8 ± 1.3	1.8 ± 0.91	[21]
	9	1.1 ± 0.2		2.6 ± 0.9		2.3 ± 1.5		[22]
RDP_SS+1	9	2.0 ± 0.7		2.3 ± 1.2		2.5 ± 1.9		[22]
	10	2		3		2	2	[23]

¹Significantly different in the original study.

Values are reported as mean ± SD. Propensity score matched between single-port laparoscopic distal pancreatectomy (LDP) and multi-port LDP cohorts. MP_LDP: Multi-port laparoscopic distal pancreatectomy; RP_LDP: Reduced-port laparoscopic distal pancreatectomy; RDP_SS+1: Robotic distal pancreatectomy with single-site plus one-port.

Table 4 Average of the means and average of the standard deviations for age, body mass index, operating time, blood loss, tumor size, spleen preservation rate, complication rate, hospital stay, and follow-up duration for multi-port laparoscopic distal pancreatectomy, reduced-port laparoscopic distal pancreatectomy, and robotic distal pancreatectomy with single-site plus one-port

Type		MP_LDP	RP_LDP	RDP_SS+1
Age		51.5 ± 14.3	51.4 ± 15.3	43.5 ± 14.2
BMI		26.2 ± 3.9	24.7 ± 3.7	21.8 ± 4
Operation time (min)		168 ± 62.7	211.9 ± 54.2	189.3 ± 70.1
Blood loss (mL)		234.2 ± 389.9	146.9 ± 165.1	24.3 ± 22
Tumor size (cm)		3.2 ± 2	3.2 ± 1.7	2.9 ± 1.2
Spleen preservation rate (%)		55.6 ± 7.3	48 ± 34	27.4 ± 17.3
Complication rate (%)	POPF	23.4 ± 4.5	27.4 ± 18.4	7.7 ± 13.3
	Others	23.0 ± 14.1	24.8 ± 18.5	21.2 ± 24.5
Hospital stay (d)		9.8 ± 7.4	10 ± 8.2	7.1 ± 1.8
Follow-up duration (mo)		37.8 ± 22.3	23.7 ± 17.3	7.8 ± 7.1

MP_LDP: Multi-port laparoscopic distal pancreatectomy; RP_LDP: Reduced-port laparoscopic distal pancreatectomy; RDP_SS+1: Robotic distal pancreatectomy with single-site plus one-port; BMI: Body mass index; POPF: Postoperative pancreatic fistula.