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Laparoscopic versus open distal pancreatectomy: a single-institution case-control study

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Abstract

Background

Laparoscopic distal pancreatic surgery has gained popularity in the last decade. However, well-designed studies comparing laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP) are limited. We present a single-institution case-control study comparing outcomes of LDP to ODP.

Methods

From a prospectively accruing database, 104 patients who underwent distal pancreatectomy for pancreatic pathologies were eligible. Of these, 30 LDPs were matched with 30 ODPs using a 1:1 case-match design. Matching criteria were final histopathologic diagnosis and lesion size. Twelve LDPs were excluded from analysis because of lack of adequate ODP controls. In all cases, an attempt was made at conservation of the spleen.

Results

There were more females in the LDP group (p = 0.001). Other clinicopathologic characteristics of the LDP and ODP groups such mean age (52.4 ± 17.2 vs. 59 ± 12.8, p = 0.104), prior history of upper abdominal surgery (6.7% vs. 20.0%, p = 0.254) or pancreatitis (13.3% vs. 10.0%, p = 1.000), histopathologic diagnosis (p = 1.000), lesion size on imaging (3.7 ± 2.7 vs. 4.4 ± 2.4 cm, p = 0.170), and histopathology (3.8 ± 2.3 vs. 4.3 ± 2.3, p = 0.386) were comparable. There were no significant differences in postoperative complication rates (50.0% vs. 43.3%, p = 0.604), major complication rates (20% vs. 20%, p = 0.829), grade B/C pancreatic fistula rates (16.7% vs. 13.3%, p = 0.717), or reoperation rates (3.3% vs. 6.7%, p = 1.000) between LDP and ODP groups, respectively. There was a significantly higher rate of splenic conservation in the LDP group (70% vs. 30%, p = 0.002). The intraoperative blood loss (294 ± 245 vs. 726 ± 709 ml, p < 0.001) and mean duration of hospitalization (8.7 ± 4.2 vs. 12.6 ± 8.7 days, p = 0.009) were significantly lower in the LDP group compared to the ODP group.

Conclusion

LDP is a safe and feasible option for distal pancreatic resections in experienced centers. The postoperative complication rate is comparable to that of ODP. LDP is associated with lower operative blood loss, higher rate of splenic conservation, and shorter duration of hospitalization. These encouraging results demand further validation in prospective randomized trials.

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Disclosure

Drs. Sanket Sharad Mehta, Ghalia Doumane, Thibault Mura, David Nocca, and Jean-Michel Fabre have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Digestive Surgery, Hospital Saint-Eloi, 80, Avenue Auguste Fliche, 34295, CHU Montpellier, France

    Sanket Sharad Mehta, Ghalia Doumane, David Nocca & Jean-Michel Fabre

  2. CHRU Montpellier, Centre d’Investigation Clinique, Montpellier, France

    Thibault Mura

  3. Inserm, CIC 1001, Montpellier, France

    Thibault Mura

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  1. Sanket Sharad Mehta
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  2. Ghalia Doumane
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Correspondence to Jean-Michel Fabre.

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Mehta, S.S., Doumane, G., Mura, T. et al. Laparoscopic versus open distal pancreatectomy: a single-institution case-control study. Surg Endosc 26, 402–407 (2012). https://doi.org/10.1007/s00464-011-1887-7

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  • DOI: https://doi.org/10.1007/s00464-011-1887-7

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