Kooby DA, Gillespie T, Bentrem D, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches

Winship Cancer Institute, Emory University School of Medicine, 1365C Clifton Rd, NE, 2nd floor, Atlanta, GA 30322, USA.
Annals of surgery (Impact Factor: 8.33). 09/2008; 248(3):438-46. DOI: 10.1097/SLA.0b013e318185a990
Source: PubMed


To compare perioperative outcomes of laparoscopic left-sided pancreatectomy (LLP) with traditional open left-sided pancreatectomy (OLP) in a multicenter experience.
LLP is being performed more commonly with limited data comparing results with outcomes from OLP.
Data from 8 centers were combined for all cases performed between 2002-2006. OLP and LLP cohorts were matched by age, American Society of Anesthesiologists, resected pancreas length, tumor size, and diagnosis. Multivariate analysis was performed using binary logistic regression.
Six hundred sixty-seven LPs were performed, with 159 (24%) attempted laparoscopically. Indications were solid lesion in 307 (46%), cystic in 295 (44%), and pancreatitis in 65 (10%) cases. Positive margins occurred in 51 (8%) cases, 335 (50%) had complications, and significant leaks occurred in 108 (16%). Conversion to OLP occurred in 20 (13%) of the LLPs. In the matched comparison, 200 OLPs were compared with 142 LLPs. There were no differences in positive margin rates (8% vs. 7%, P = 0.8), operative times (216 vs. 230 minutes, P = 0.3), or leak rates (18% vs. 11%, P = 0.1). LLP patients had lower average blood loss (357 vs. 588 mL, P < 0.01), fewer complications (40% vs. 57%, P < 0.01), and shorter hospital stays (5.9 vs. 9.0 days, P < 0.01). By MVA, LLP was an independent factor for shorter hospital stay (P < 0.01, odds ratio 0.33, 95% confidence interval 0.19-0.56).
In selected patients, LLP is associated with less morbidity and shorter LOS than OLP. Pancreatic fistula rates are similar for OLP and LLP. LLP is appropriate for selected patients with left-sided pancreatic pathology.

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    • "The three largest studies published in recent years included overall collectives of 103–159 patients undergoing laparoscopic distal pancreatectomy. Among these, only 4, 13 and 16 pancreatic cancers were found [25,89,90]. This limited data does not allow conclusions to be drawn on the oncological feasibility of laparoscopic distal pancreatectomy. "
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    ABSTRACT: Pancreatic cancer is still associated with a poor prognosis and remains-as the fourth leading cause of cancer related mortality-a therapeutic challenge. Overall long-term survival is about 1-5%, and in only 10-20% of pancreatic cancer patients is potentially curative surgery possible, increasing five-year survival rates to approximately 20-25%. Pancreatic surgery is a technically challenging procedure and has significantly changed during the past decades with regard to technical aspects as well as perioperative care. Standardized resections can be carried out with low morbidity and mortality below 5% in high volume institutions. Furthermore, there is growing evidence that also more extended resections including multivisceral approaches, vessel reconstructions or surgery for tumor recurrence can be carried out safely with favorable outcomes. The impact of adjuvant treatment, especially chemotherapy, has increased dramatically within recent years, leading to significantly improved postoperative survival, making pancreatic cancer therapy an interdisciplinary approach to achieve best results.
    Cancers 12/2011; 3(1):1253-73. DOI:10.3390/cancers3011253
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    • "It must be performed only to remove small tumours on the surface of the pancreas, with a distance of more than 2-3 mm between the tumour and the pancreatic duct (Finlayson & Clark 2004). Providing that the tumour present with the above mentioned characteristics, and that surgery is performed by experienced surgeons, the risk of pancreatic fistula is not higher than that observed in larger resections of the pancreas (Kooby et al. 2008). When tumour enucleation is not possible, central pancreatectomy for a tumour in the pancreatic neck or adjacent body is preferred by several groups (Muller et al. 2006; Crippa et al. 2007; Zhao et al. 2011), in order to preserve a functional pancreatic gland, and to reduce the risks of post-operative pancreatic exocrine deficiency and diabetes mellitus (Crippa et al. 2007; Hirono et al. 2009). "
    Basic and Clinical Endocrinology Up-to-Date, 10/2011; , ISBN: 978-953-307-340-8
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    • "General morbidity rate and perioperative hemorrhage is generally lower for laparoscopic procedures6, but there is no conclusive evidence that minimally invasive surgery leads to reduced POPF rate after distal pancreas resections. Various centers have published different rates of POPF varying from 0% to 32% as defined by the International study group on pancreatic fistulas (ISGPF).7 In our institution, the overall fistula rate after laparoscopic resections of the pancreas has been 10%.2 "
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    ABSTRACT: Postoperative pancreatic fistula (POPF) is a severe complication after pancreatic resections. The aim was to assess if application of TachoSil® patch could reduce incidence of postoperative fistulas after laparoscopic distal pancreatic resections. This is a retrospective study of prospectively collected data after enucleations and distal pancreatic resections. Patients were divided in two groups: with or without application of TachoSil® patch. Demographic and surgical data were analyzed. One hundred twenty-one patients with distal pancreatic resections without additional resections were identified among 230 patients operated by laparoscopic approach at our institution since 1998. They were divided into two groups. In group 1 (n = 48), TachoSil® patch was not applied while in group 2 (n = 73), the pancreatic stump was covered with TachoSil®. Postoperative fistulas were registered in 8% (4/48) and 12% (9/73) in groups 1 and 2, respectively. The median duration of postoperative hospital stay in group 1 was 5.5 (2-35) days compared with 5 (2-16) days in group 2. No significant difference in surgical outcomes was found. The application of the TachoSil® patch did not affect either occurrence of POPF or duration of postoperative hospital stay. Routine use of TachoSil® patch to prevent pancreatic fistulas does not provide clinically significant benefit.
    Journal of Gastrointestinal Surgery 06/2011; 15(9):1625-9. DOI:10.1007/s11605-011-1584-9 · 2.80 Impact Factor
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