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Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach

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Abstract

Background

Laparoscopic left pancreatic resections are being increasingly performed. In this study, we provide a nonrandomized comparison between laparoscopic and open left pancreatectomy (OLP) for benign and borderline tumors, focusing on both perioperative and long-term results.

Methods

Demographic, pathologic, and perioperative details from patients who underwent laparoscopic and OLP between 1999 and 2006 were retrieved from our database and analyzed. Long-term results, including resume to full-time work, occurrence of incisional hernias, and incidence of exocrine and endocrine insufficiency also were evaluated.

Results

A total of 116 patients were included in the analysis; 43 (37.1%) were managed laparoscopically and 73 (62.9%) underwent the open procedure. There were no significant differences regarding clinical and pathological data. All of the resections attempted laparoscopically were completed. The rate of splenic preservation was significantly higher in the laparoscopic group (P = 0.0001). Postoperative outcomes were similar between the two groups. Longitudinal comparison between two time periods (1999–June 2004 vs. July 2004–2006) showed that pancreatic fistula and hospital stay significantly diminished over time in the laparoscopic group (P = 0.04 and P = 0.004, respectively). Median follow-up was 53 months. The incidence of exocrine insufficiency and incisional hernias was significantly higher after open resections (both P = 0.05). After hospital discharge, median time to resume full-time work was 6 weeks in the open group and 3 weeks after laparoscopic resections (P < 0.0001). Laparoscopy also resulted as an independent factor for an early resume to full-time activities in the multivariate analysis (P < 0.0001).

Conclusions

Laparoscopic left pancreatectomy is a safe procedure for benign and borderline tumors, with similar perioperative outcomes compared with the open procedure. In the long term, the laparoscopic approach is likely to be superior thanks to a more rapid resume of full-time activities and to the lower incidence of incisional hernias and exocrine insufficiency. Clearly, these results have yet to be confirmed in large, randomized trials.

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References

  1. Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410

    Article  PubMed  CAS  Google Scholar 

  2. Cuschieri A (1994) Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 39:178–184

    PubMed  CAS  Google Scholar 

  3. Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82

    Article  PubMed  Google Scholar 

  4. Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado MA, Navarro S (2007) Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg 11:1607–1621

    Article  PubMed  Google Scholar 

  5. Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF, Pancreatic Hepatobiliary Section (HBPS) of the Royal Belgian Society of Surgery, Belgian Group for Endoscopic Surgery (BGES), Club Coelio (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605

    Article  PubMed  Google Scholar 

  6. Nakamura Y, Uchida E, Aimoto T, Matsumoto S, Yoshida H, Tajiri T (2009) Clinical outcome of laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Surg 16:35–41

    Article  PubMed  Google Scholar 

  7. Taylor C, O’Rourke N, Nathanson L, Martin I, Hopkins G, Layani L, Ghusn M, Fielding G (2008) Laparoscopic distal pancreatectomy: the Brisbane experience of forty-six cases. HPB 10:38–42

    Article  PubMed  CAS  Google Scholar 

  8. Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B (2008) A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 143:289–295

    Article  PubMed  Google Scholar 

  9. Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 19:1028–1034

    Article  PubMed  CAS  Google Scholar 

  10. Pryor A, Means JR, Pappas TN (2007) Laparoscopic distal pancreatectomy with splenic preservation. Surg Endosc 21:2326–2330

    Article  PubMed  CAS  Google Scholar 

  11. Matsumoto T, Hirano S, Yada K, Himeno Y, Shibata K, Aramaki M, Kawano K, Kitano S (2005) Safety and efficacy of laparoscopic distal pancreatectomy for the treatment of pancreatic disease. J Hepatobiliary Pancreat Surg 12:65–70

    Article  PubMed  Google Scholar 

  12. Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145:19–23

    Article  PubMed  Google Scholar 

  13. Luo Y, Liu R, Hu MG, Mu YM, An LC, Huang ZQ (2009) Laparoscopic surgery for pancreatic insulinomas: a single-institution experience of 29 cases. J Gastrointest Surg 13:945–950

    Article  PubMed  Google Scholar 

  14. Isla A, Arbuckle JD, Kekis PB, Lim A, Jackson JE, Todd JF, Lynn J (2009) Laparoscopic management of insulinomas. Br J Surg 96:185–190

    Article  PubMed  CAS  Google Scholar 

  15. Fernández-Cruz L, Blanco L, Cosa R, Rendón H (2008) Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors? World J Surg 32:904–917

    Article  PubMed  Google Scholar 

  16. Fernández-Cruz L, Martínez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8:493–501

    Article  PubMed  Google Scholar 

  17. Kooby DA (2008) Laparoscopic pancreatic resection for cancer. Expert Rev Anticancer Ther 8:1597–1609

    Article  PubMed  Google Scholar 

  18. Croce E, Olmi S, Bertolini A, Magnone S (2005) Laparoscopic surgery of pancreatic cancer: state of the art. Hepatogastroenterology 52:1889–1994

    PubMed  Google Scholar 

  19. Velanovich V (2006) Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 10:95–98

    Article  PubMed  Google Scholar 

  20. Tang CN, Tsui KK, Ha JP, Wong DC, Li MK (2007) Laparoscopic distal pancreatectomy: a comparative study. Hepatogastroenterology 54:265–271

    PubMed  CAS  Google Scholar 

  21. Teh SH, Tseng D, Sheppard BC (2007) Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J Gastrointest Surg 11:1120–1125

    Article  PubMed  Google Scholar 

  22. Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW (2008) Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc 22:1334–1338

    Article  PubMed  CAS  Google Scholar 

  23. Bruzoni M, Sasson AR (2008) Open and laparoscopic spleen-preserving, splenic vessel-preserving distal pancreatectomy: indications and outcomes. J Gastrointest Surg 12:1202–1206

    Article  PubMed  Google Scholar 

  24. Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22:2261–2268

    Article  PubMed  Google Scholar 

  25. Matsumoto T, Shibata K, Ohta M, Iwaki K, Uchida H, Yada K, Mori M, Kitano S (2008) Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech 18:340–343

    Article  PubMed  Google Scholar 

  26. Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC 2nd, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446

    PubMed  Google Scholar 

  27. Finan KR, Cannon EE, Kim EJ, Wesley MM, Arnoletti PJ, Heslin MJ, Christein JD (2009) Laparoscopic and open distal pancreatectomy: a comparison of outcomes. Am Surg 75:671–679

    PubMed  Google Scholar 

  28. Baker MS, Bentrem DJ, Ujiki MB, Stocker S, Talamonti MS (2009) A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery 146:635–643

    Article  PubMed  Google Scholar 

  29. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  30. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25

    Article  PubMed  Google Scholar 

  31. Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553

    Article  PubMed  CAS  Google Scholar 

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Disclosures

Drs. Giovanni Butturini, Stefano Partelli, Stefano Crippa, Giuseppe Malleo, Roberto Rossini, Luca Casetti, Gianluigi Melotti, Micaela Piccoli, Claudio Bassi, and Paolo Pederzoli state that they do not have commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, etc.) that might pose a conflict of interest in connection with the present article. The authors also state that the research described here did not benefit from any source of financial support or commercial sponsorship.

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Authors and Affiliations

  1. Department of Surgery, G.B. Rossi Hospital, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy

    Giovanni Butturini, Stefano Partelli, Stefano Crippa, Giuseppe Malleo, Roberto Rossini, Luca Casetti, Paolo Pederzoli & Claudio Bassi

  2. Department of General Surgery, S. Agostino Estense Hospital, Baggiovara, Modena, Italy

    Gian Luigi Melotti & Micaela Piccoli

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  1. Giovanni Butturini
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  2. Stefano Partelli
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  3. Stefano Crippa
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  4. Giuseppe Malleo
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  5. Roberto Rossini
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  6. Luca Casetti
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  7. Gian Luigi Melotti
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  9. Paolo Pederzoli
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  10. Claudio Bassi
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Correspondence to Giovanni Butturini.

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Butturini, G., Partelli, S., Crippa, S. et al. Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach. Surg Endosc 25, 2871–2878 (2011). https://doi.org/10.1007/s00464-011-1634-0

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  • DOI: https://doi.org/10.1007/s00464-011-1634-0

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