National trends in resection of the distal pancreas

Abstract

There appears to be an overall underutilization of laparoscopy for DP. Centralization does not appear to be occurring. Survival and lymph node harvest have not changed.

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

“…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).…”

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

“…Nevertheless, Rosales-Velderrain et al [6] have reported that, in the United States, only a low percentage (15%-27%) of patients with body/tail pancreatic tumors were subjected to LDP. To our knowledge, there are no data regarding the diffusion of LDP in Europe, especially in Italy.…”

“…On the other hand, the scenario seems to be different, in the United States, LDPs have frequently been used for malignant neoplasms. However, Rosales-Velderrain et al [6] reported that it is impossible to clearly extract the correlation between hospital volume and type of lesion. There was no difference in operative time in HVCs and LVCs in our study.…”

“…Rosales-Velderrain et al [6] have recently reported that, in the United States, the use of LDP for benign and malignant body/tail pancreatic lesions is low, accounting for only 15%-27% of all distal pancreatectomies. Data regarding the Italian scenario are lacking even if at the 45th Annual Meeting of the European Pancreatic Club, Balzano et al [7] reported a brief description regarding the diffusion of the laparoscopic technique for distal pancreatectomy in Italy.…”

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

“…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]. The current evidence comparing postoperative outcomes of open to laparoscopic DP for pancreatic adenocarcinoma is growing, but is still scarce until now [12].…”