A Case-matched Comparative Study of Laparoscopic Versus Open Distal Pancreatectomy. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: Khaled, Yazan S.; Malde, Deep J.; Packer, Jessica; De Liguori Carino, Nicola; Deshpande, Rahul; O'Reilly, Derek A.; Sherlock, David J.; Ammori, Basil J.
• Is Part Of: Surgical laparoscopy endoscopy & percutaneous techniques. Volume 25:Issue 4(2015)
• Publication Date: 2015-08
• Subjects: distal pancreatectomy -- pancreatic ductal adenocarcinoma -- pancreatic neuroendocrine tumors -- laparoscopic pancreatectomy -- pancreatic fistula; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Endoscopy -- Periodicals; Laparoscopy -- Periodicals; 617.550597
• DOI: 10.1097/SLE.0000000000000179
• Languages: English
• ISSNs: 1530-4515

Abstract

Abstract : Introduction: Although the laparoscopic approach to distal pancreatectomy for benign and malignant diseases is largely replacing open surgery in some centers, well-designed studies comparing these approaches are limited. We present a case-matched study that compares the outcomes of laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP). Methods: Of 112 patients (51 female) who underwent surgery between January 2002 and December 2011, 44 patients were matched on a 1:1 basis (22 LDP, 22 ODP) according to age, sex, and tumor size. Outcomes were compared on an intention-to-treat basis. Data shown represent median where appropriate. Results: The laparoscopic and open groups were comparable for age (57 vs. 59.9 y, P= 0.980), sex distribution ( P= 1.000), tumor size (3 vs. 4 cm, P= 0.904), and the frequency of benign versus malignant disease ( P= 0.920). LDP was associated with significantly lower blood loss (100 vs. 500 mL, P= 0.001), higher spleen preservation rate (45% vs. 18%, P= 0.029), as well as shorter high dependency unit stay (1 vs. 5 d, P= 0.001) and postoperative hospital stay (5 vs. 14 d, P= 0.017). There was no significant difference in operating time (245 vs. 240 min, P= 0.602) and postoperative morbidity (13.6% vs. 27.2%, P= 0.431). In patients with malignant disease, there were no differences in R 0 resection margin status (90% vs. 85.7%, P= 0.88), the numbers of lymph nodes retrieved (12.7 vs. 14.1, P= 0.82), the 1- and 2-year survival rates (89% vs. 81%, P= 0.54 and 74.2% vs. 71.5%, P= 0.63, respectively), and the mean duration of survival (45 vs. 31 mo, P= 0.157). Conclusions: The laparoscopic approach to distal pancreatectomy offers advantages over open surgery in terms of reductions in operative trauma and duration of postoperative recovery without compromising the oncologic resection.