Abstract
Introduction
The laparoscopic approach to distal pancreatectomy (DP) for benign and malignant diseases appears to offer advantages and is replacing open surgery in some centers. This review examined the evidence from published data of comparative studies of laparoscopic versus open DP.
Methods
The Medline and PubMed databases were searched and relevant English language publications were systematically retrieved. Data were pooled by two independent reviewers. The results shown represent mean.
Results
Up to December 2010, 13 comparative studies of laparoscopic versus open DP were identified of which two were excluded, leaving 503 and 588 patients respectively for analysis. The conversion rate was 9.5%. The groups were comparable for age and sex, whilst open surgery was associated with significantly higher incidence of malignant pathology (20.1 vs. 15.0%) and larger tumors (3.9 vs. 3.5 cm) compared with laparoscopic surgery. There were no differences between the two approaches with regard to the operative time (220 vs. 208 min), rate of postoperative pancreatic fistula (16.1 vs. 19.5%), and mortality (0.6 vs. 0.5%). However, the laparoscopic approach was associated with significantly lower operative blood loss (237 vs. 562 ml), higher spleen preservation rate (37.8 vs. 8%), lower morbidity (30.5 vs. 38.4%), and shorter postoperative hospital stay (9.1 vs. 14.7 days).
Conclusions
The laparoscopic approach to DP offers advantages over open surgery with lower operative morbidity, higher spleen preservation rate, and shorter hospital stay; these benefits are particularly observed in patients with benign disease and borderline malignancy. The experience with laparoscopic DP for malignant disease remains limited, and long-term follow-up data are required to clearly define this role.
Similar content being viewed by others
References
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 (Oxford) 10:38–42
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
Corcione F, Marzano E, Cuccurullo D, Caracino V, Pirozzi F, Settembre A (2006) Distal pancreas surgery: outcome of 19 cases managed with a laparoscopic approach. Surg Endosc 20:1729–1732
Velanovich V (2006) Case control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 10:95–98
Tang CN, Tsui KK, Ha JPY, Wong DCT, Li MKW (2007) Laparoscopic distal pancreatectomy: a comparative study. Hepatogastroenterology 54:265–271
Teh SH, Tseng D, Sheppard BC (2007) Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J Gastrointest Surg 11:1120–1125
Bruzoni M, Sasson AR (2008) Open and laparoscopic spleen-preserving, splenic vessel-preserving distal pancreatectomy: indications and outcomes. J Gastrointest Surg 12:1202–1206
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
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 Technol 18:340–343
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
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 75:671–680
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 146:635–645
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
Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RCG, 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
Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, Donohue JH, Farnell MB, Kendrick ML (2010) Laparoscopic vs. open distal pancreatectomy; a single-institution comparative study. Arch Surg 145:616–621
Aly MY, Tsutsumi K, Nakamura M, Sato N, Takahata S, Ueda J, Shimizu S, Redwan AA, Tanaka M (2010) Comparative study of laparoscopic and open distal pancreatectomy. J Laparoendosc Adv Surg Technol A 20:435–440
Bassi C, Butturuni G, Molinari E et al (2005) Post operative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Sarr MG (2003) Pancreatic surgery group. The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double blinded, randomized, placebo-controlled trial. J Am Coll Surg 196:556–564
Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95:2S–4S
Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PWT (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196
Knaebel HP, Diener MK, Wente MN, Büchler MW, Seiler CM (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92:539–546
Abu Hilal M, Jain G, Kasasbeh F, Zuccaro M, Elberm H (2009) Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre. Surg Endosc 23:2743–2747
Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RC (2002) Long term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg 236:612–618
Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137:164–168
Rodriguez JR, Madanat MG, Healy BC, Thayer SP, Warshaw AL, Fernandez-del Castillo C (2007) Distal pancreatectomy with splenic preservation revisited. Surgery 141:619–625
Mabrut JY, Fernandez-Cruz L, Azagra JS et al (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605
Brady MS, Rogatko A, Dent LL, Shiu MH (1991) Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg 126:359–364
Varty PP, Linehan IP, Boulos PB (1993) Does concurrent splenectomy at colorectal cancer resection influence survival? Dis Colon Rectum 36:602–606
Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210:779–787
Fernandez-Cruz L, Cosa R, Blanco L, Levi S, Lopez-Boado MA, Navarro S (2007) Curative laparoscopic resection for pancreatic neoplasm: a critical analysis from a single institution. J Gastrointest Surg 11:1607–1621
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jusoh, A.C., Ammori, B.J. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 26, 904–913 (2012). https://doi.org/10.1007/s00464-011-2016-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-2016-3