Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment

Braga, Marco; Pecorelli, Nicolò; Ferrari, Denise; Balzano, Gianpaolo; Zuliani, Walter; Castoldi, R.

doi:10.1007/s00464-014-3879-x

Cited by 55 publications

(44 citation statements)

References 33 publications

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“…Although it is difficult to evaluate the influence of this procedure on outcome, we feel that our positive surgical and postoperative results are probably related in part to this maneuver. Compared to other series, our mean operative time was shorter for DP (174 vs. 193-239 min) [13][14][15] and the conversion rate was also very low (3 vs. 23-33%) [9,14,15] . A shorter mean operative time was also noted for CP (191 vs. 225-480 min) [16][17][18][19][20] as well as a very low conversion rate (3 vs. 17-22%) [16,17] .…”

Section: Discussioncontrasting

confidence: 62%

Hanging Maneuver for Stomach Traction in Laparoscopic Distal Pancreatic Resections: An Original Technique Applied in 218 Patients

et al. 2016

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Background: Stomach traction done to expose the pancreas is still a problem in laparoscopic left pancreatic resections. We developed a simple hanging maneuver to retract the stomach rapidly and effectively. Methods: After dividing the gastrocolic ligament, the stomach was encircled with a tape, turned along its horizontal axis and pulled with an epigastric trocar, which was later removed. This technique was used in all patients who underwent laparoscopic left pancreatic resections including 165 distal pancreatectomies (DP), 35 central pancreatectomies (CP) and 18 enucleations (En). Demographics, surgical and postoperative outcome data were recorded. Results: There were no mortalities. The mean operative time for DP, CP and En were 174, 191 and 104 min, respectively. The transfusion (0-4%) and conversion (0-3%) rates were low for all procedures. Morbidity was mainly represented by pancreatic fistula and grades (B + C) for DP, CP and En were observed in 26, 22 and 17%, respectively. No complication related to hanging of the stomach, like gastric perforation, was observed. Re-intervention and the mean hospital stay for DP, CP and En were observed in 5, 11 and 0% and were 16, 22 and 12, respectively. The readmission rate was low (0-9%). Conclusions: Hanging maneuver of the stomach is a simple procedure to rapidly, safely and effectively retract the stomach during left laparoscopic pancreatic resections.

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Section: Discussioncontrasting

confidence: 62%

Hanging Maneuver for Stomach Traction in Laparoscopic Distal Pancreatic Resections: An Original Technique Applied in 218 Patients

et al. 2016

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“…[20] Consistent with previous studies, [14,15] our operative time for LDP was longer than for ODP (median 195.5 vs. 112.5 min). Shin et al [22] reported a median operative time of 195 min for LDP, whereas Braga et al [28] reported a median duration of surgery of 239 min for LDP, significantly higher than that for ODP (213 min), but their series included a high rate (30%) of adenocarcinomas. Another group reported a longer operative time for LDP (376 min vs. 274 min).…”

Section: Discussionmentioning

confidence: 98%

“…Consistent with our findings, Fox et al [39] found a shorter LoS and a reduction of total hospital costs for LDP (n = 42), compared with ODP (n = 76), showing that LoS was directly proportional to total costs. Interestingly, Braga et al [28] suggested that the cost-benefit analysis should consider not only the hospital charges, but also the cosmesis and quality of life of the patients to fully evaluate the minimally invasive approach. Notably, in our study the postoperative complications and readmission rate were similar.…”

Section: Discussionmentioning

confidence: 99%

“…Particularly, longterm data on recurrence of pancreatic carcinomas are scarce, and larger comparative studies are needed. [20] Rehman et al [28] found no significant differences in 3-year OS between laparoscopic (n = 8) or open (n = 14) distal pancreatectomy for pancreatic adenocarcinoma (82% vs. 74%). Similarly, Hu et al [50] compared 11 LDP and 23 ODP and found a mean OS 42.0 ± 8.6 months vs. 54.0 ± 5.8 months.…”

Section: Discussionmentioning

confidence: 99%

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Mini-invasive distal pancreatectomy: a feasible and cost-effective technique

Basso¹,

Maffeis²,

Lumachi³

et al. 2017

MIS

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Aim: Laparoscopic pancreatic surgery is a minimally invasive technique that has been widely applied only in the past decade. The purpose of this study was to evaluate its safety and assess whether laparoscopic distal pancreatectomy (LDP) is cost-effective compared with open distal pancreatectomy (ODP). Methods: The medical records of patients treated for leftsided pancreatic lesions were retrospectively analysed, and the analysis of costs for hospital stay, operative time, and equipment were analysed. Twelve patients underwent LDP, while 12 patients underwent ODP. Results: The two groups were homogeneous according to age, ASA score, BMI, and distribution of pathological findings. Both the size of the specimen (5.33 ± 3.2 vs. 5.58 ± 2.57 cm) and the number of removed lymph nodes (10.5 ± 4.3 vs. 12.1 ± 3.1) did not differ. Although LDP required a longer operative time (197.5 ± 33.7 vs. 122.5 ± 35.4 min), intraoperative bleeding, postoperative pain intensity (measured by VAS scale) and hospital stay were significantly reduced. Conclusion: The mini-invasive approach offers several advantages compared with open surgery, including a significant reduction of blood loss and postoperative pain, and an earlier recovery. The global costs of laparoscopic surgery should be carefully re-evaluated, considering the saving that arises from these advantages. Key words:Mini-invasive, distal pancreatectomy, laparoscopy, cost ABSTRACTArticle history:

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“…Finally, the introduction of laparoscopy into surgery of the body and tail of the pancreas may have positive impact on post-operative quality of life [47, 48]. At the same time, the direct costs of the surgical procedure are higher comparing to open distal pancreatectomy; however, they can be probably balanced with reduced post-operative costs [37].…”

Section: Laparoscopic Distal (Left) Pancreatectomy (Ldp)mentioning

confidence: 99%

Minimally invasive pancreatic cancer surgery: What is the current evidence?

et al. 2017

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Surgery remains the only option to cure pancreatic cancer. Although the use of laparoscopy in oncology is rapidly growing worldwide, its efficacy in pancreatic surgery remains controversial. A number of studies have compared outcomes of minimally invasive and open pancreatic resections. However, they are mostly non-randomized trials including relatively small groups of patients. In addition, most of these studies were conducted in high-volume pancreatic centres. It seems that despite longer operative time, laparoscopy may be beneficial in terms of morbidity, blood loss and hospital stay. Thus far, very little is known about the long-term outcomes of laparoscopic surgery for pancreatic cancer. Our aim was to review current evidence for the use of minimally invasive techniques in patients with pancreatic malignancy.

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Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment

Cited by 55 publications

References 33 publications

Hanging Maneuver for Stomach Traction in Laparoscopic Distal Pancreatic Resections: An Original Technique Applied in 218 Patients

Hanging Maneuver for Stomach Traction in Laparoscopic Distal Pancreatic Resections: An Original Technique Applied in 218 Patients

Mini-invasive distal pancreatectomy: a feasible and cost-effective technique

Minimally invasive pancreatic cancer surgery: What is the current evidence?

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