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Laparoscopic distal pancreatectomy for pancreatic cancer is safe and effective

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Abstract

Purpose

To compare the short-term and oncologic outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) undergoing laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP).

Methods

Consecutive cases of distal pancreatectomy (DP) (n = 422) were reviewed at a single high-volume institution over a 10-year period (2005–2014). Inclusion criteria consisted of any patient with PDAC by surgical pathology. Ninety-day outcomes were monitored through a prospectively maintained pancreatic resection database. The Social Security Death Index was used for 5-year survival. Two-way statistical analyses were used to compare categories; variance was reported with standard error of the mean; * indicates P value <0.05.

Results

Seventy-nine patients underwent DP for PDAC. Thirty-three underwent LDP and 46 ODP. There were no statistical differences in demographics, BMI, and ASA classification. Intraoperative and surgical pathology variables were comparable for LDP versus ODP: operative time (3.9 ± 0.2 vs. 4.2 ± 0.2 h), duct size, gland texture, stump closure, tumor size (3.3 ± 0.3 vs. 4.0 ± 0.4 cm), lymph node harvest (14.5 ± 1.1 vs. 17.5 ± 1.2), tumor stage (see table), and negative surgical margins (77 vs. 87%). Patients who underwent LDP experienced lower blood loss (310 ± 68 vs. 597 ± 95 ml; P = 0.016*) and required fewer transfusions (0 vs. 13; P = 0.0008*). Patients who underwent LDP had fewer positive lymph nodes (0.8 ± 0.2 vs. 1.6 ± 0.3; P = 0.04*) and a lower incidence of type C pancreatic fistula (0 vs. 13%; P = 0.03*). Median follow-up for all patients was 11.4 months. Long-term oncologic outcomes revealed similar outcomes including distant or local recurrence (30 vs. 52%; P = 0.05) and median survival (18 vs. 15 months), as well as 1-year (73 vs. 59%), 3-year (22 vs. 21%), and 5-year (20 vs. 15%) survival for LDP and ODP, respectively.

Conclusions

The results of this series suggest that LDP is a safe surgical approach that is comparable from an oncologic standpoint to ODP for the management of pancreatic adenocarcinoma.

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Abbreviations

ACS-NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

DP:

Distal pancreatectomy

PDAC:

Pancreatic adenocarcinoma

PF:

Pancreatic fistula

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 541, Indianapolis, IN, 46202, USA

    Marita D. Bauman, David G. Becerra, E. Molly Kilbane, Nicholas J. Zyromski, C. Max Schmidt, Henry A. Pitt, Attila Nakeeb, Michael G. House & Eugene P. Ceppa

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  1. Marita D. Bauman
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  2. David G. Becerra
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  3. E. Molly Kilbane
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  4. Nicholas J. Zyromski
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Correspondence to Marita D. Bauman.

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Disclosures

Drs. Marita D. Bauman, David G. Becerra, E. Molly Kilbane, RN BSN, Nicholas J. Zyromski, C. Max Schmidt, Henry A. Pitt, Attila Nakeeb, Michael G. House, and Eugene P. Ceppa have no conflicts of interest or financial ties to disclose.

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Bauman, M.D., Becerra, D.G., Kilbane, E.M. et al. Laparoscopic distal pancreatectomy for pancreatic cancer is safe and effective. Surg Endosc 32, 53–61 (2018). https://doi.org/10.1007/s00464-017-5633-7

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  • DOI: https://doi.org/10.1007/s00464-017-5633-7

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