A Prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy
ABSTRACT Laparoscopic distal pancreatectomy (LP) is an emerging modality for managing benign and premalignant neoplasms of the pancreatic body and tail. The efficacy of LP has been examined in single and multi-institutional retrospective reviews but not compared prospectively to open distal pancreatectomy (ODP).
We maintain a prospectively accruing database tracking peri-operative clinical parameters for all patients presenting to our tertiary care facility for treatment of pancreatic disease. We queried this database for patients undergoing LP or ODP between January 2003 and May 2008. Preoperative, operative, and postoperative characteristics were compared using standard statistical methods.
One-hundred twelve patients underwent distal pancreatectomy. Eighty-five underwent SDP. Twenty-eight LPs were attempted and 27 completed laparoscopically. One LP was converted to an open procedure because of bleeding and was excluded from study. In comparison to ODP, patients undergoing LP had statistically similar pre-operative demographics, disease comorbidities, tumor size, length of operation, rates of postoperative mortality, postoperative morbidity, and pancreatic fistula. Patients undergoing LP were less likely to have ductal adenocarcinoma and had fewer lymph nodes harvested in their resection but had a significantly shorter postoperative length of stay and significantly lower estimated blood loss than those undergoing ODP.
Laparoscopic distal pancreatectomy is a safe, effective modality for managing premalignant neoplasms of the pancreatic body and tail, providing a morbidity rate comparable to that for ODP and substantially shorter length of stay. Laparoscopic distal pancreatectomy fails to provide a lymphadenectomy comparable to ODP. This may limit the applicability of LP to the treatment of pancreatic adenocarcinoma.
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ABSTRACT: Laparoscopic distal pancreatectomy is regarded as a feasible and safe surgical alternative to open distal pancreatectomy for lesions of the pancreatic tail and body. The aim of the present systematic review was to provide recommendations for clinical practice and research on the basis of surgical morbidity, such as pancreas fistula, delayed gastric empting, safety, and clinical significance of laparoscopic versus open distal pancreatectomy for malignant and nonmalignant diseases of the pancreas. A systematic literature search (MEDLINE) was performed to identify all types of studies comparing laparoscopic distal pancreatectomy and open distal pancreatectomy. Random effects meta-analyses were calculated after critical appraisal of the included studies and presented as odds ratios or mean differences each with corresponding 95% confidence intervals. A total of 4,148 citations were retrieved initially; available data of 29 observational studies (3,701 patients overall) were included in the meta-analyses. Five systematic reviews on the same topic were found and critically appraised. Meta-analyses showed superiority of laparoscopic distal pancreatectomy in terms of blood loss, time to first oral intake, and hospital stay. All other parameters of operative morbidity and safety showed no difference. Data on oncologic radicality and effectiveness are limited. Laparoscopic distal pancreatectomy seems to be a safe and effective alternative to open distal pancreatectomy. No more nonrandomized trials are needed within this context. A large, randomized trial is warranted and should focus on oncologic effectiveness, defined end points, and cost-effectiveness. Copyright © 2015 Elsevier Inc. All rights reserved.Surgery 01/2015; 157(1):45-55. DOI:10.1016/j.surg.2014.06.081 · 3.11 Impact Factor
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ABSTRACT: In this study, we aimed to assess the technique and results of spleen-preserving laparoscopic distal pancreatectomy (SPLDP) on the basis of two cases. The first case was a woman with a large cystic papillary lesion of the distal pancreas. The other patient was a woman with a pancreatic mass on the tail of the pancreas. Both patients were operated on using SPLDP. Five trocars were used in the first case and four trocars were used in the second case. Thirty degree telescope visualization and LigaSure dissection were used during the operation. The splenic vessels were dissected, but the short gastric vessels were preserved. The pancreas was transected by one Endo GIA stapler and the cut edge of the pancreas was reinforced with sutures to prevent a pancreatic fistula. We performed the same technique in both cases. However, in the first case, we aspirated the content of the cystic mass of the pancreas before removing it to avoid making a large incision. The duration of the operation was 190 and 135 minutes, respectively. There were no postoperative complications. SPLDP is a safe, effective modality for managing lesions of the distal pancreas. If the splenic vessels are transected, the short gastric vessels must be protected to ensure the viability of the spleen.Turkish Journal of Surgery 12/2013; 29(3):139-143. DOI:10.5152/UCD.2013.1888
Pancreatology 05/2013; 13(3):S88. DOI:10.1016/j.pan.2013.04.309 · 2.50 Impact Factor