Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution

Abstract

The use of LDPR for benign lesions of the distal pancreas is feasible and safe. The LDPR procedure is associated with operative times and complication rates similar to those for ODPR, but LDPR has the advantages of an earlier return to normal bowel movements and normal diet and shorter hospital stays than ODPR.

Laparoscopic pancreatectomy: Indications and outcomes

“…[15] 5.9/8.6 a 0%/4.8% NS N/A 50%/46% 3.26/7.73 a 25%/42% a 0 N/A Nakamura et al [16] 10/25. [17] 6.2/9 N/A 14.2%/0% N/A N/A 2.3/3.8 0%/0% 0 N/A Eom et al [18] 11.5/13.5 a 0 35.5%/24.2% N/A 9.7%/6.5% 3.95/6.15 a 9.7%/6.5% N/A N/A Kim et al [19] 10/16 a 0 24.7%/29% N/A 8.6%/14.3% 3/3 0 N/A N/A Matsumoto et al [20] 12.9/23.8 a 0 7.1%/21.1% N/A 0%/10.5% 3.0/3.4 0 N/A N/A Misawa et al [21] 10/16 a 0 N/A N/A 0%/22% 7.5/2 0%/0% N/A N/A Tang et al [22] 7/11 0 33.3%/0% N/A 22.2%/0% N/A 0%/0% 0%/0% N/A Teh et al [23] 6.2/10.6 a 0 16.7%/56.2% a 0 8.3%/6.2% 3.4/3.4 0%/0% N/A N/A Velanovich et al [24] 5/8 a N/A 20%/27% N/A 13%/13% N/A 20%/32% N/A N/A Fernández-Cruz et al [25] 6 pancreaticoduodenectomy. A summary of series that compare the pre-operative, intra-operative and post-operative factors and outcomes in MIPD and OPD at their institutions is shown in Tables 3 and 4 [35][36][37][38] .…”

“…Although there is a lack of randomized trials comparing LDP and ODP, there have been many retrospective series in the past decade studying the post-operative outcomes of LDP ( Table 2). The main advantages of LDP include shorter hospital stay (difference of 2 d or more) [2][3][4][5][6]9,[11][12][13][14][15][16][19][20][21]23,24] , decreased requirement for pain medications, and swifter return to regular diet (difference of 1.7 d) [19] . The overall morbidity is approximately 26%-40% [2,10,11,13] , which is similar to ODP from contemporary series (29%-57%).…”

“…As a result, the application of laparoscopy to pancreatectomy has been slower compared to other abdominal procedures. As surgeons become more adept at advanced laparoscopy, there is increasing evidence demonstrating not only the safety and feasibility of laparoscopic pancreatic [3] 42/76 27.3/26.5 NS 35.7%/22.4% 304/281 375/375 11.9% Mehta et al [4] 30/30 N/A N/A 70%/30% a 188/226 294/729 a N/A Limongelli et al [5] 16/29 26.4/27.1 NS 31%/14% 204/160 a 160/365 a 6.0% Soh et al [6] 10/21 25/21 NS N/A 383/330 275/600 a N/A Butturini et al [7] 43/73 N/A N/A 44.2%/11% a 180/180 N/A 0.0% Cho et al [8] 254/439 NS NS 34%/10% a NS 24%/54% (> 300cc) 9.4% Aly et al [9] 40/35 21/21 N/A 32%/8% a 342/250 a 363/606 a 10.0% DiNorcia et al [10] 71/192 N/A NS 15.5%/15.6% 250/270 a 150/900 a 25.3% Jayaraman et al [11] 107/236 27/27 N/A 21%/14% 194/163 a 150/350 a 30.0% Kooby et al [12] 23/189 28.5/26.2 NS N/A 238/230 422/790 a 17.0% Vijan et al [13] 100/100 27.4/27.9 NS 25%/N/A 214/208 171/519 a 4.0% Baker et al [14] 27/85 N/A NS N/A 236/253 219.4/612.6 a 3.6% Finan et al [15] 44/104 28.3/26.9 NS 2%/2.7% 156/200 a 157/719 a 4.1% Nakamura et al [16] 21 [17] 7/4 29.5/29 N/A 100%/100% 182/152 214/362 0.0% Eom et al [18] 31 [19] 93 [20] 14/19 N/A NS N/A 290.7/213.8 a 247.1/400.3 7.0% Misawa et al [21] 8/9 N/A N/A 12.5%/0% 255/205 14/307 a 0.0% Tang et al [22] 9/5 N/A NS 55.6%/0% 180/210 100/450 a 0.0% Teh et al [23] 12 [24] 15/15 N/A N/A 0%/0% N/A N/A 20.0% Fernández-Cruz et al [25] 5/41…”

Laparoscopic Pancreatic Surgery

“…Although laparoscopic pancreatic surgery is considered to be an advanced and demanding procedure, many surgeons have tried laparoscopic distal pancreatectomy due to its technical simplicity and its avoidance of the need for anastomosis as compared with other difficult pancreatectomy (Table 1) (Weber et al, 2009;Mabrut et al, 2005;Melotti et al, 2007;Vijan et al, 2010;Fernandez-Cruz et al, 2007;Røsok et al, 2010;DiNorcia et al, 2010;Jayaraman et al, 2010;Kooby et al, 2008;Song et al, 2011;Velanovich, 2006;Misawa et al, 2007;Teh et al, 2007;Kim et al, 2008;Matsumoto et al, 2008;Eom et al, 2008;Nakamura et al, 2009).…”

“…( Vijan et al, 2010;Kooby et al, 2008;Velanovich, 2006;Misawa et al, 2007;Teh et al, 2007;Kim et al, 2008;Matsumoto et al, 2008;Eom et al, 2008;Nakamura et al, 2009). …”