Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Abstract

Laparoscopic approaches exist for most operations traditionally performed using open techniques, and an increasing number of organ resections are being performed laparoscopically. The potential benefits of laparoscopic over the open approach include reduced operative blood loss, fewer surgical complications, shorter hospital stays, and faster recovery times. Cholecystectomy and adrenalectomy are two such examples of organ resections more commonly performed laparoscopically than open in the United States, as the complexity of these operations is relatively low for experienced surgeons in properly selected patients. Laparoscopic colectomy had a slower evolution given the increased complexity of the procedure, but the value of the laparoscopic approach was demonstrated through several multicenter randomized trials [1,2], facilitated by the relatively large number of colectomies performed annually.Momentum for minimally invasive pancreatectomy (MIP) has been slower -likely due to the retroperitoneal location of the organ, its intimate relationship with the main mesenteric vessels, the complexity of the surgery, the inherent risk of postoperative pancreatic fistula (POPF) formation, and the relatively lower volume of cases, as compared with cholecystectomy and colectomy [3]. Of pancreatic resections, distal pancreatectomy (DP) is the most commonly achieved laparoscopically [4]. First reported in 1994, laparoscopic distal pancreatectomy (LDP) is being performed with increasing frequency worldwide despite a lack of randomized data supporting this approach over standard open distal pancreatectomy (ODP). Approximately one quarter of all DPs are performed using minimally invasive approaches [5].Drs Nakamura and colleagues from 69 medical centers in Japan used a sophisticated statistical method (propensity score matching -PSM) to address the comparison of two surgical techniques (LDP and ODP) for removing the left side of the pancreas [6]. The key findings between the two cohorts after PSM are that compared with ODP, LDP is associated with lower blood loss (254 ± 384 vs. 499 ± 740, <0.001), fewer blood transfusion (4% vs. 6.8%, P = 0.02), fewer grade B and C POPF (18.4% vs. 28.2%, P < 0.001), a higher percentage of splenic preservations (29.9% vs. 13.2%, P < 0.001), and shorter hospital stays (18.8 ± 14.7 vs. 23.2 ± 18.8, P = 0.001). In great part, these results support data from prior studies.In 2008 Results of this study demonstrated that there were no significant differences in OR time (216 vs. 230 min; P = 0.3), development of major pancreatic fistula (18% vs. 11%; P = 0.1), major complication (17% vs. 10%; P = 0.08), or 30-day mortality (1% vs. 0%; P = 0.040) between the groups (ODP vs. LDP, respectively). As compared with ODP, LDP was associated with lower estimated blood loss

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

“…[19]. Our series with 10 cases showed a count of retrieved lymph nodes of 15 (range, [13][14][15][16][17][18][19][20][21],and the R0 resection rate of 100.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].So whether LRAMPS could achieve better oncological outcomes than laparoscopic conventional DPS or similar…”

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy: Preliminary Experience with 10 Cases

“…[19]. Our series with 10 cases showed a count of retrieved lymph nodes of 15 (range, [13][14][15][16][17][18][19][20][21],and the R0 resection rate of 100.0%, similar to what have been reported in the literature [5][6][7][8][9][10][11].So whether LRAMPS could achieve better oncological outcomes than laparoscopic conventional DPS or similar oncological outcomes as open RAMPS need more randomized controlled test to con rm. No study to date has shown improved overall survival between RAMPS and standard DP [21][22][23].…”

“…Laparoscopic distal pancreatectomy(LDP) has been recognized as a standard technique for benign or borderline malignant neoplasms. The ndings that LDP is associated with lower estimated blood loss, faster recovery than open distal pancreatectomy have increased interest in the procedure [17,18]. Due to recent technological developments, LDP has been expanded to treat PC by LRAMPS.…”

Standardizing terminology for minimally invasive pancreatic resection

“…The term pancreatoduodenectomy is preferred since pancreaticoduodenectomy, although frequently used, is considered grammatically incorrect. 33,34 Similarly, distal pancreatectomy 35,36 and left pancreatectomy 37,38 or central pancreatectomy 39,40 and middle pancreatectomy 41,42 have been used equivalently. The eponymous Whipple surgery 43,44 and Traverso-Longmire surgery 45 or descriptive names such as PPPD, 29,46 SSPPD 47,48 and PRPD 49,50 are used to indicate the extent of gastric or pyloric resection.…”