Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: Feasibility, safety and cost analysis

Richardson, John R.; Fabio, Francesco Di; Clarke, Hannah F.; Bajalan, Mohammed; Davids, Joe; Hilal, Mohammed Abu

doi:10.1016/j.pan.2015.01.002

Cited by 48 publications

(58 citation statements)

References 20 publications

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“…Median ward stay was 3 days (range 1–30 days). An enhanced recovery programme was introduced during the series which brought hospital stay down to as low as 2 days [24]. Five patients were readmitted within 30 days (1 with nausea and vomiting, 2 with peripancreatic collections and 2 to manage post-operative pancreatic fistulae).…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results

et al. 2015

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BackgroundLaparoscopic left pancreatectomy has been well described for benign pancreatic lesions, but its role in pancreatic adenocarcinoma remains open to debate. We report our results adopting a laparoscopic technique that obeys established oncologic principles of open distal pancreatosplenectomy.MethodsThis is a post hoc analysis of a prospectively kept database of 135 consecutive patients undergoing laparoscopic left pancreatectomy, performed across two sites in the UK and the Netherlands (07/2007–07/2015 Southampton and 10/2013–07/2015 Amsterdam). Primary outcomes were resection margin and lymph node retrieval. Secondary endpoints were other perioperative outcomes, including post-operative pancreatic fistula. Definition of radical resection was distance tumour to resection margin >1 mm. All patients underwent ‘laparoscopic radical left pancreatosplenectomy’ (LRLP) which involves ‘hanging’ the pancreas including Gerota’s fascia, followed by clockwise dissection, including formal lymphadenectomy.ResultsLRLP for pancreatic adenocarcinoma was performed in 25 patients. Seven of the 25 patients (28 %) had extended resections, including the adrenal gland (n = 3), duodenojejunal flexure (n = 2) or transverse mesocolon (n = 3). Mean age was 68 years (54–81). Conversion rate was 0 %, mean operative time 240 min and mean blood loss 340 ml. Median intensive/high care and hospital stay were 1 and 5 days, respectively. Clavien–Dindo score 3+ complication rate was 12 % and ISGPF grade B/C pancreatic fistula rate 28 %; 90-day (or in-hospital) mortality was 0 %. The pancreatic resection margin was clear in all patients, and the posterior margin was involved (<1 mm) in 6 patients, meaning an overall R0 resection rate of 76 %. No resection margin was microscopically involved. Median nodal sample was 15 nodes (3–26). With an average follow-up of 17.2 months, 1-year survival was 88 %.ConclusionsA standardised laparoscopic approach to pancreatic adenocarcinoma in the left pancreas can be adopted safely. Our study shows that these results can be reproduced across multiple sites using the same technique.

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Section: Resultsmentioning

confidence: 99%

Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results

et al. 2015

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“…One explanation might be that the vast majority of the patients included in these meta-analyses underwent open surgery. Possibly, the laparoscopic approach has a greater favorable impact on the short-term outcomes leading less complications regardless of the splenic preservation, as it is previously demonstrated that laparoscopic distal pancreatectomy is associated with lower morbidity [29][30][31][32], shorter hospital stay, and less blood loss [12,29,30] compared to open distal pancreatectomy. Moreover, it is likely that treatment allocation bias played a role in these meta-analyses, as all studies included were retrospective cohort studies that analyzed cases of unplanned splenectomy in the DPS group.…”

Section: Discussionmentioning

confidence: 99%

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

et al. 2019

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Background The laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery. Although favorable postoperative short-term outcomes have been reported in open spleen-preserving distal pancreatectomy when compared to distal pancreatectomy with splenectomy, it is unclear whether this observation applies to the laparoscopic approach. The aim of this study is to compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LDPS). Study design This is a UK wide, propensity score-matched study, including patients who underwent LSPDP or LDPS between 2006 and 2016. Short-term outcomes were compared between LSPDP and LDPS according to intention to treat. Additionally, risk factors for unplanned splenectomy were explored. Results A total of 456 patients were included from eleven centers (229 LSPDP and 227 LDPS). We were able to match 173 LSPDP cases to 173 LDPS cases, according to intention to treat. No differences were seen in postoperative morbidity between the groups. The only identified risk factor for unplanned splenectomy was tumor size ≥ 30 mm. Conclusions Preserving the spleen during laparoscopic distal pancreatectomy is not associated with a lower postoperative morbidity compared to sacrificing the spleen. Tumor size is a risk factor for unplanned splenectomy.Keywords Laparoscopic distal pancreatectomy · Laparoscopic spleen-preserving distal pancreatectomy · Splenectomy · Benign · Low-grade malignant and Other Interventional TechniquesThe members of the Minimally Invasive liver and Pancreatic Surgery Study Group-UK (MI-LAPS UK) have been included in Acknowledgement section.

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“…The implementation of this program decreased length of hospital stay by 3 days and resulted in a significant total cost reduction of 2000 GBP per patient (P = 0.0004). 21 Two studies compared costs between LDP and RDP. 22,23 In both, a higher operative costs were reported in the RDP group, yet the study from Kang and co-workers found that overall cost (inclusive of postoperative costs) favors RDP.…”

Section: Costs Of Distal Pancreatectomymentioning

confidence: 99%

Minimally invasive pancreatic resections: cost and value perspectives

Conlon

Rooij²,

Hilst³

et al. 2017

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Challenges remain as to how the potential benefits, both to the patient and the healthcare system as a whole, are measured. Research comparing MIPR versus other techniques for pancreatectomy will require appropriate and valid measurement tools, some of which are yet to be refined. Nonetheless, the experience to date would support the continued development of MIPR by experienced surgeons in high-volume pancreatic centers, married with appropriate review and recalibration.

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Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: Feasibility, safety and cost analysis

Cited by 48 publications

References 20 publications

Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results

Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

Minimally invasive pancreatic resections: cost and value perspectives

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