Laparoscopic and Open Distal Pancreatectomy: A Comparison of Outcomes

Abstract

Laparoscopic (lap) pancreatic surgery has been increasingly reported since its introduction in 1992. A retrospective analysis of consecutive patients undergoing elective lap and open distal pancreatectomy from 2002 to 2007 was performed. Univariate analysis was completed to evaluate perioperative variables. Logistic regression analysis was used to model predictors of postoperative pancreatic fistula. One hundred forty-eight subjects underwent distal pancreatectomy; 98 completed open, 44 lap, and six converted to open. There was no significant difference in the incidence of postoperative morbidity or mortality between the surgical approaches. Decreased operative time (156 vs 200 minutes, P < 0.01), blood loss (157 vs 719 mL, P < 0.01), and length of stay (5.9 vs 8.6 days, P < 0.01) were seen in the lap group. There was no significant difference in the rate of all pancreatic fistula formation (50 vs 46%, P = 0.94) or clinically significant leaks (18 vs 19%, P = 0.97) between techniques. A preoperative biopsy-proven cancer, increasing body mass index, history of pancreatitis, and male gender were significant predictors of having a pancreatic fistula. Lap and open distal pancreatectomy are performed safely at high-volume pancreatic surgery centers. This report provides ongoing support of the feasibility and safety of the lap approach with improved perioperative outcomes and equivalent pancreatic fistula rate.

Pancreatic stump closure techniques and pancreatic fistula formation after distal pancreatectomy: Meta-analysis and single-center experience

“…Therefore, we also performed a systematic review of the PF rates after laparoscopic versus open DP. A total of 17 studies [ 26 , 46 – 61 ] (4 prospective, 13 retrospective, S1 Table ) with 4,389 patients were identified that reported on the fistula rates in simultaneous comparison of both techniques ( Fig 5B ). Here, there was no overt difference in the overall (OR 1.08, 0.84 to 1.39; p = 0.55, Fig 5B ) or clinically relevant grade B/C PF rates (OR 1.08, 0.76 to 1.53; p = 0.66, Fig 5B , S1 and S2 Tables) after laparoscopic versus open DP.…”

Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta‐analysis of laparoscopic pancreatectomy

“…For comparison of LDP with ODP, a total of 592 articles were reviewed, 24 of which were selected and included in this analysis (Supplemented Figure 1) []. The 24 included trials were published between 2002 and 2012.…”

Minimally invasive pancreatic surgery - a review.

“…In different series, operating time is reported as longer [ 14 – 17 ], similar [ 18 – 25 ] or shorter [ 26 – 28 ] compared with the open approach: this may be explained by the difference in the surgeons’ learning curve [ 29 ]. A series that compares operating time for LDP and ODP reports ranges of 180 [ 20 ] to 383 [ 30 ] min (LDP) and 152 [ 31 ] to 330 [ 30 ] min (ODP).…”

“…Some authors have reported a significant reduction in conversion rate associated with the robotic approach [ 32 , 37 ]. Conversion to open surgery implies greater intraoperative blood loss [ 18 , 21 , 38 ] and longer operating time [ 26 , 28 ]. Reasons for conversion include high BMI, adhesions, large and proximal lesions and intraoperative bleeding.…”