Article

A Prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy

Department of Surgery, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem Campus, Evanston, IL 60201, USA.
Surgery (Impact Factor: 3.38). 10/2009; 146(4):635-43; discussion 643-5. DOI: 10.1016/j.surg.2009.06.045
Source: PubMed

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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    • "2008 Laparoscopy Laparotomy 93 35 52 ± 14.7 52.9 ± 11.7 0% 195 (82—453) 190 (88—482) Nk Nk 8.6% 14.3% 24.7% 29% 0% 0% 0% 0% Nk Nk 10 (5—36) a 16 (8—65) a Baker et al. [15] 2009 Laparoscopy Laparotomy 27 85 59.2 ± 3.2 59.3 ± 1.6 0% 236.0 ± 82 253.2 ± 292.3 219.4 ± 30.6 a 612.6 ± 80.7 a 22% 14% 37% 35.10% 0% 2% 4.1% a 21.1% a Nk Nk 4.0 ± 0.3 a 8.6 ± 0.7 a Finan et al. [16] 2009 Laparoscopy Laparotomy 44 104 60.5 ± 59 55.5 ± 63 12% 156 a 200 a 157 a 719 a 18% 19% Nk Nk Nk Nk Nk Nk Nk Nk 5.9 a 8.6 a Aly et al. [18] 2010 Laparoscopy Laparotomy 40 35 47 ± 16 52 ± 16 10% 342 ± 133 a 250 ± 98 a 363 ± 549 a 606 ± 602 a 12% 17% 20% 31% 0% 0% 0% 0% Nk Nk 22 ± 16 a 27 ± 13 a DiNorcia et al. [19] 2010 Laparoscopy Laparotomy 71 192 58.2 ± 14.1 60.2 ± 15.2 25.3% 191 (163—214) 195 (166—263) 150 (100—250) a 900 (400—1400) a 11.3% 14.1% 28.2% a 43.8% a 0% 1.0% 4.2% a 30.2% a 97% 87% 5 (4—6) a 6 (5—8) a Jayaraman et al. [20] 2010 Laparoscopy Laparotomy 100 100 Nk Nk 33% 195 a 160 a 175 a 300 a 15% 13% 20% 17% 0% 0% Nk Nk 97% 98% 5 a 6 a Table 1 (Continued) Author Year Approach n Mean age Conversion Duration of operation Blood loss Fistula Severe morbid- ity Mortality Adenocarcinoma R0 margin Duration of hospital stay Kooby et al. [4] 2010 Laparoscopy Laparotomy 23 70 64.6 ± 12.3 65.9 ± 11.1 17% 238 ± 68 216 ± 69 422 ± 473 751 ± 853 Nk Nk Nk Nk Nk Nk 100% 100% 74% 66% 7.4 ± 3.4 9.4 ± 4.7 Vijan et al. [22] 2010 Laparoscopy Laparotomy 100 100 59.0 ± 17.3 58.6 ± 15.2 4% 214 208 171 a 519 a 17% 17% 34% 29% 3% 1% 17% 19% 100% 100% 6.1 ± 2.4 a 8.6 ± 5.9 a Zhao et al. [23] 2010 Laparoscopy Laparotomy 30 42 47.5 ± 12.91 46.2 ± 12.0 3.3% 186 ± 359149 ± 29 223 ± 144 251 ± 103 Nk Nk 17% 28% Nk Nk Nk Nk 100% 100% 7.4 ± 1.6 a 9.7 ± 1.4 a Butturini et al. [26] 2011 Laparoscopy Laparotomy 43 73 48 53 0% 180 180 Nk Nk 27.9% 13.7% 48.2% 45.2% 0% 0% 0% 0% Nk Nk 8 9 Mehta et al. [27] 2012 Laparoscopy Laparotomy 30 30 52.3 ± 17.2 59.0 ± 12.8 Nk 188 ± 72 226 ± 87 294 ± 245 a 726 ± 709 a 16.7% 13.3% 20% 20% 0% 3.3% 23% 23% Nk Nk 8.7 ± 4.2 a 12.6 ± 8.7 a Fox et al. [28] 2012 Laparoscopy Laparotomy 42 76 55.3 ± 16.4 58.4 ± 14.4 11.9% 304 (265—348) 281 (247—333) 375 (200—800) 375 (200—700) 28.6% a 13.4% a 21.4% 19.7% Nk Nk 4.8% 2.6% Nk Nk 5 (4—6) a 7 (6—9) a Abu-Hilal et al. [25] 2012 Laparoscopy Laparotomy 35 16 60 (17—78) 63 (18—79) 0 (0%) 200 (120—420) 225 (120—460) 200 (0—900) a 394 (75—2000) a 29% 44% 40% 69% 0% 6% 11% 19% 75% 66.6% 7 (3—25) a 11 (5—46) a Nk: not known. a Statistically significant difference. "
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    ABSTRACT: Laparoscopic distal pancreatectomy is currently a commonly performed procedure. Twenty-five retrospective studies comparing laparotomy and laparoscopy have dealt with the feasibility of this approach for localized benign and malignant tumors. However, these studies report several different techniques. The aim of this review was to determine if a standardized procedure could be proposed. Based on the literature and the experience of surgeons in the French Association of Hepatobiliary Surgery and Liver Transplantation (ACBHT-Association française de chirurgie hépato-biliaire et de transplantation hépatique), we recommend primary control of the splenic artery, use of linear staplers for pancreatic transection, splenic vein control either at its end or its origin, and, depending on local conditions, preservation of the splenic vessels when splenic preservation is envisioned. Current data do not allow establishment of any definitive recommendations as to the ideal site of pancreatic transection, operative patient position, or the direction of dissection, which mainly depends on local practices. Control of the splenic vein remains the critical point of this procedure, and impacts the intra-operative strategy. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Full-text · Article · May 2015 · Journal of Visceral Surgery
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    • "2008 Laparoscopie 93 52 ± 14,7 0 % 195 (82—453) nc 8,6 % 24,7 % 0 % 0 % nc 10 (5—36) a Ouverte 35 52,9 ± 11,7 190 (88—482) nc 14,3 % 29 % 0 % 0 % nc 16 (8—65) a Baker et al. [15] 2009 Laparoscopie 27 59,2 ± 3,2 0 % 236,0 ± 82 219,4 ± 30,6 a 22 % 37 % 0 % 4,1 % a nc 4,0 ± 0,3 a Ouverte 85 59,3 ± 1,6 253,2 ± 292,3 612,6 ± 80,7 a 14 % 35,10 % 2 % 21,1 % a nc 8,6 ± 0,7 a Finan et al. [16] 2009 Laparoscopie 44 60,5 ± 59 12 % 156 a 157 a 18 % nc nc nc nc 5,9 a Ouverte 104 55,5 ± 63 200 a 719 a 19 % nc nc nc nc 8,6 a Aly et al. [18] 2010 Laparoscopie 40 47 ± 16 10 % 342 ± 133 a 363 ± 549 a 12 % 20 % 0 % 0 % nc 22 ± 16 a Ouverte 35 52 ± 16 250 ± 98 a 606 ± 602 a 17 % 31 % 0 % 0 % nc 27 ± 13 a DiNorcia et al. [19] 2010 Laparoscopie 71 58,2 ± 14,1 25,3 % 191 (163—214) 150 (100—250) a 11,3 % 28,2 % a 0 % 4,2 % a 97 % 5 (4—6) a Ouverte 192 60,2 ± 15,2 195 (166—263) 900 (400—1400) a 14,1 % 43,8 % a 1,0 % 30,2 % a 87 % 6 (5—8) a Jayaraman et al. [20] 2010 Laparoscopie 100 nc 33 % 195 a 175 a 15 % 20 % 0 % nc 97 % 5 a Ouverte 100 nc 160 a 300 a 13 % 17 % 0 % nc 98 % 6 a Tableau 1 (Suite) Auteur Année Voie d'abord n Âge moyen Conversion Durée opératoire Pertes sanguines Fistule Morbidité sévère Mortalité Adénocarcinome Marge R0 Durée d'hospitalisation Kooby et al. [4] 2010 Laparoscopie 23 64,6 ± 12,3 17 % 238 ± 68 422 ± 473 nc nc nc 100 % 74 % 7,4 ± 3,4 Ouverte 70 65,9 ± 11,1 216 ± 69 751 ± 853 nc nc nc 100 % 66 % 9,4 ± 4,7 "
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    ABSTRACT: La pancréatectomie gauche (PG) par abord laparoscopique est aujourd’hui une procédure validée : 25 études rétrospectives comparant laparotomie et laparoscopie ont démontré la faisabilité de cette voie d’abord pour les lésions bénignes et malignes localement peu avancées. Cependant, ces études rapportent de nombreuses variantes techniques et le but de cette mise au point est de déterminer si une standardisation peut être proposée pour cette procédure. À partir des données de la littérature et de l’expérience française de l’Association de chirurgie hépato-biliaire et de transplantation hépatique (ACHBT), il paraît licite d’établir certaines recommandations, telles que le contrôle premier de l’artère splénique, l’utilisation d’agrafeuses linéaires pour la section parenchymateuse pancréatique, le contrôle de la veine splénique à sa terminaison et/ou à son origine, la ligature et/ou section systématique de l’artère en cas de ligature de la veine splénique, et en fonction des conditions locales, la conservation des vaisseaux spléniques lorsqu’une conservation splénique est envisagée. Les données actuelles ne permettent en revanche pas d’émettre des recommandations concernant le site idéal de section pancréatique, le type d’installation, et le sens de dissection pancréatique, qui reste affaire d’école. Le contrôle de la veine splénique reste le point critique de cette intervention et va conditionner la stratégie peropératoire.
    Full-text · Article · May 2015 · Journal de Chirurgie Viscerale
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    • "Laparoscopic surgery for pancreatic diseases has gained interest among surgeons in the past decade.22 Benign and premalignant pancreatic body and tail cystic lesions can be treated with laparoscopic distal pancreatectomy (LDP).23 LDP can generally be performed with or without splenectomy.24 "
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    ABSTRACT: Background: Solitary true pancreatic cysts (STPCs), or epithelial cysts, are benign lesions that are extremely rare in adult patients. Advances in radiographic techniques have improved the ability to identify pancreatic cystic lesions. We report a case of a large and symptomatic STPC in a 47-year-old female patient who was treated successfully with spleen-preserving laparoscopic distal pancreatectomy. We also review the clinical and pathologic features of all reported STPCs within the past 25 years. Database: To compose the review, we did a search of the international literature for STPCs that had occurred in adults. Fourteen related articles were found describing cases of STPCs. Clinical and pathologic information was collected for all of the reported pancreatic cysts, and a database was formed. STPCs are detected more frequently in women than in men. The mean age of occurrence is 43.2 years, and the mean cyst size is 5.6 cm. Fifty percent of true cysts are located in the head of the pancreas. Size and site are responsible for the symptoms caused, although 22.8% were asymptomatic. Diagnosis was made postoperatively in all cases by histopathologic studies. No case of malignancy was reported in any STPC. Conclusions: STPCs are rare and benign lesions commonly discovered incidentally during abdominal imaging. Surgical treatment is considered the appropriate therapy for large and symptomatic STPCs. The definitive diagnosis is established by histopathologic and immunohistochemical studies.
    Full-text · Article · Apr 2014 · JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
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