LDP vs ODP for pancreatic adenocarcinoma: a case matched study from a single-institution

Abstract

BackgroundLaparoscopic distal pancreatectomy (LDP) showed advantage of perioperation outcomes for benign and low-grade tumor of the pancreas. The application of LDP for pancreatic ductal adenocarcinoma (PDAC) didn’t gain popular acceptance and the number of LDP for PDAC remains low. We designed a case-matched study to analysis the short- and long-term outcomes of the patients undergoing either Laparoscopic distal pancreatectomy or open distal pancreatectomy for PDAC.MethodFrom 2003 to 2013, 17 patients were underwent LDP and 34 patients were underwent ODP for PDAC were matched by tumor size, age and body mass index (BMI). The two groups’ demographic information, perioperative outcomes and survival data were compared.ResultsBaseline characteristics were comparable between the LDP and ODP groups. The intraoperative blood loss, first flatus, first oral intake and postoperative hospital stay were significantly less in LDP group than ODP group (50 ml vs400ml, P = 0.000; 3d vs 4d, P = 0.001; 3d vs 4d, P = 0.003; 13d vs 15.5d, P = 0.022). The mean operation time, overall postoperative morbidity and postoperative pancreatic fistula rates were similar in the two groups. 5 patients (29.4 %) in LDP group and 7 patients (20.6 %) in ODP group underwent extended resections. There were no significant differences in tumor sizes (3.5 cm vs 3.9 cm, P = 0.664) and number of harvested lymph nodes (9 vs8 P = 0.534). The median overall survival for both groups was 14.0 months. Cox proportional hazards analysis showed extended resections, R1 resection, perineural invasion and tumor differentiation were associated with worse survival.ConclusionLDP is technically feasible and safe for PDAC in selected patients and the short-term oncologic outcomes were not inferior to ODP in this small sample study. However the long-term oncologic safety of LDP for PDAC has to be further evaluated by multicenter or randomized controlled trials.

Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy – A single-center series

“…They also found less blood loss and need for intraoperative transfusion, which was not the case in the present study. Zhang et al in a small case-matched study found also a diminution of the LoS (13 vs. 15.5 days) [7]. On the contrary a retrospective study by Hasselgren et al showed no difference in the LoS but a diminution of blood loss with laparoscopy [19].…”

Laparoscopic pancreatic resections: review of feasibility, safety and outcome

“…The morbidity in laparoscopic resections are reported as similar to open(2,9) Laparoscopic pancreatic surgery involves a challenging learning curve and literature indicate further studies to recommend it's routine use (2,5,7,9). This case series provide a discussion on laparoscopic pancreatic resections, in a tertiary care center, in view of feasibility and outcome.…”

“…Minimal access resection will minimize the incision and provide a better vision during surgery by magnification and zooming (8) with reduced blood loss (2,3,4,5,9).…”

“…The duration of surgery compared to open, is more in Laparoscopic pancreaticoduodenectomy(LPD) (2) whilst similar in distal resections (9). The learning curve is less steeper for distal resections (6).…”

Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy - A single-center series

“…More recently, several studies reported favorable short-term outcomes like shorter operative times, less postoperative complications, and decreased length of stay (LoS) [7], [8], [9]. A major concern for laparoscopic DP was to maintain oncologic standards for the resection of adenocarcinomas of the body and tail of the pancreas [10], [11].…”