Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis

Limongelli, Paolo; Belli, Andrea; Russo, Gianluca; Cioffi, Luigi; D’Agostino, Alberto; Fantini, Corrado; Belli, Giulio

doi:10.1007/s00464-011-2141-z

Cited by 82 publications

(77 citation statements)

References 25 publications

(24 reference statements)

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“…A LDP that is not converted to open is associated with significantly less intra-operative blood loss compared to ODP in many series [2,[4][5][6][10][11][12]14,16,21,23] . The usual rate of conversion to ODP is about 10%-20% (Table 1), but can be over 25% in series with less selected patients [11,32] .…”

Section: Surgical Technique and Intra-operative Considerationsmentioning

confidence: 99%

“…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%).…”

Section: Post-operative Outcomesmentioning

confidence: 99%

“…Marangos et al [33] found that the 3-year survival [5] 6.4/8.8 a 0%/3% 25%/41% 0%/7% 18%/20% 3.2/4.3 a 37%/45% 6%/7% N/A Soh et al [6] 5 [7] 8/9 0 48.2/45.2% 9.3%/9.6% 29.7%/13.7% 3.9/4.0 4.7%/2.7% N/A N/A Cho et al [8] 16%/54% (> 7d) 0.5%/1% 12%/15% 1%/3% 23%/27% 40%/58% (> 3.5 cm)…”

Section: Oncologic Outcomesmentioning

confidence: 99%

“…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…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic pancreatectomy: Indications and outcomes

Liang

Hameed

Jayaraman

2014

WJG

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The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and shortterm oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons' experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. Key words: Laparoscopy; Distal pancreatectomy; Pancreaticoduodenectomy; Robotic pancreatectomy; Enucleation Core tip: This review discusses recent advances in laparoscopic distal pancreatectomy (LDP), minimally invasive pancreaticoduodenectomy (MIPD), and enucleation. Recent studies show that LDP have improved perioperative recovery and equivalent oncologic outcomes. Studies on MIPD demonstrate that it is safe in terms of intra-operative outcomes, post-operative recovery and early oncologic outcomes; however, it requires advanced laparoscopic skills. Laparoscopic enucleation has become the operation of choice for small benign tumours that are away from the main pancreatic duct, especially insulinomas. We also summarize key results in pre-operative, perioperative and post-operative outcomes from contemporary series comparing open and laparoscopic pancreatic resections in the tables.

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Section: Surgical Technique and Intra-operative Considerationsmentioning

confidence: 99%

Section: Post-operative Outcomesmentioning

confidence: 99%

Section: Oncologic Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic pancreatectomy: Indications and outcomes

Liang

Hameed

Jayaraman

2014

WJG

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“…Of them, 2 were excluded because they had potentially redundant data, reporting data from the same institution and authors, and two articles were excluded because they contained not-extractable data. Finally, 5 studies [13][14][15][16][17] were included in the metaanalysis (Fig.). On review of the data extraction, there was 100% agreement between the two reviewers.…”

Section: Selected Studiesmentioning

confidence: 99%

Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis

Ricci

Casadei

Lazzarini

et al. 2014

Hepatobiliary & Pancreatic Diseases International

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Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy

et al. 2014

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IMPORTANCE Interest in minimally invasive distal pancreatectomy (MIDP) has grown in recent years, but currently available data are limited. Greater insight into application patterns and outcomes may begained from a national database inquiry OBJECTIVES To study trends in the use of MIDP and compare the short-term outcomes of MlDPwith those of open distal pancreatectomy. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study evaluating perioperative outcomes and hospital charge measures for distal pancreatectomy, comparing the surgical approaches and adjusting for patient- and hospital-level factors, among patients undergoing elective distal pancreatectomy from 1998 to 2009 in the Nationwide Inpatient Sample in a 20% stratified sample of all US hospitals MAIN OUTCOMES AND MEASURES In-hospital mortality, rates of perioperative complications and splenectomy, total charges, and length of stay. RESULTS A total of 8957 distal pancreatectomies were included in this analysis, of which 382 (4 3%) were MIDPs. On a national level, this projected to 42 320 open distal pancreatectomies and 1908 MlDPs. The proportion of distal pancreatectomies performed via minimally invasive approaches tripled between 1998 and 2009, from 2 4% to 7.3%. The groups were comparable for sex and comorbidity profiles, while patients who underwent MlDPwere 15 years older. On multivariate analysis. MIDP was associated with lower rates of overall predischarge complications, including lower incidences of postoperative infections and bleeding complications, as well as a shorter length of stay by 1.22 days There were no differences in rates of in-hospital mortality, concomitant splenectomy, or total charges CONCLUSIONS AND RELEVANCE This population-based study of MlDP reveals that the application of this approach has tripled in practice and provides strong evidence that MIDP has evolved into a safe option in the treatment of benign and malignant pancreatic diseases.

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Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis

Cited by 82 publications

References 25 publications

Laparoscopic pancreatectomy: Indications and outcomes

Laparoscopic pancreatectomy: Indications and outcomes

Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis

Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy

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