Skip to main content
SpringerLink
Log in

Laparoscopic Distal Pancreatectomy for Cancer Provides Oncologic Outcomes and Overall Survival Identical to Open Distal Pancreatectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic distal pancreatectomy (LDP) has been shown to provide short-term clinical outcomes similar to open distal pancreatectomy (ODP) for patients with benign tumors. Our aim was to better define oncologic outcomes and long-term survival profiles following LDP for pancreatic ductal adenocarcinoma (PDAC).

Methods

We queried the National Cancer Database to identify patients with pathologic stage I–III PDAC who underwent distal pancreatectomy between 2010 and 2013. Logistic regression was performed to examine predictors of oncologic outcomes. Cox modeling was used for survival analysis and to estimate median overall survival (OS).

Results

One thousand five hundred fifty-four patients were included in the analysis. Patients undergoing LDP and ODP demonstrated identical probabilities of an adequate lymph node sampling and 90-day mortality. Those undergoing LDP demonstrated an increased probability of margin-negative resection (OR 1.78, CI 1.25–2.52) and a decreased probability of a prolonged hospital stay (OR 0.55, CI 0.32–0.95) or readmission (OR 0.56, CI 0.33–0.95) relative to those undergoing ODP. There was no difference in OS between groups (29.6 vs. 23.8 months, p = 0.10).

Conclusion

LDP is an effective modality for managing resectable cancer in the pancreatic body and tail. LDP provides short-term oncologic outcomes and long-term OS rates identical to those for ODP while affording an accelerated recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sulpice, L., O. Farges, N. Goutte, N. Bendersky, S. Dokmak, A. Sauvanet, and J.R. Delpero, Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: time for a randomized controlled trial? Results of an all-inclusive national observational study. Ann Surg, 2015. 262(5): p. 868–73; Discussion 873-4.

    Article  PubMed  Google Scholar 

  2. Khaled, Y.S., D.J. Malde, J. Packer, N. De Liguori Carino, R. Deshpande, D.A. O'Reilly, D.J. Sherlock, and B.J. Ammori, A case-matched comparative study of laparoscopic versus open distal pancreatectomy. Surg Laparosc Endosc Percutan Tech, 2015. 25(4): p. 363–7.

    Article  PubMed  Google Scholar 

  3. Chung, J.C., H.C. Kim, and O.P. Song, Laparoscopic distal pancreatectomy for benign or borderline malignant pancreatic tumors. Turk J Gastroenterol, 2014. 25 Suppl 1: p. 162–6.

    PubMed  Google Scholar 

  4. Baker, M.S., D.J. Bentrem, M.B. Ujiki, S. Stocker, and M.S. Talamonti, A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery, 2009. 146(4): p. 635–43; Discussion 643-5.

    Article  PubMed  Google Scholar 

  5. Baker, M.S., K.L. Sherman, S. Stocker, A.V. Hayman, D.J. Bentrem, R.A. Prinz, and M.S. Talamonti, Defining quality for distal pancreatectomy: does the laparoscopic approach protect patients from poor quality outcomes? J Gastrointest Surg, 2013. 17(2): p. 273–80.

    Article  PubMed  Google Scholar 

  6. Sharpe, S.M., M.S. Talamonti, E. Wang, D.J. Bentrem, K.K. Roggin, R.A. Prinz, R.D. Marsh, S.J. Stocker, D.J. Winchester, and M.S. Baker, The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes. Am J Surg, 2015. 209(3): p. 557–63.

    Article  PubMed  Google Scholar 

  7. Stauffer, J.A., A. Rosales-Velderrain, R.F. Goldberg, S.P. Bowers, and H.J. Asbun, Comparison of open with laparoscopic distal pancreatectomy: a single institution's transition over a 7-year period. HPB (Oxford), 2013. 15(2): p. 149–55.

    Article  Google Scholar 

  8. Shin, S.H., S.C. Kim, K.B. Song, D.W. Hwang, J.H. Lee, D. Lee, J.W. Lee, E. Jun, K.M. Park, and Y.J. Lee, A comparative study of laparoscopic vs. open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis. J Am Coll Surg, 2015. 220(2): p. 177–85.

    Article  PubMed  Google Scholar 

  9. Magge, D., W. Gooding, H. Choudry, J. Steve, J. Steel, A. Zureikat, A. Krasinskas, M. Daouadi, K.K. Lee, S.J. Hughes, H.J. Zeh, 3rd, and A.J. Moser, Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg, 2013. 148(6): p. 525–31.

    Article  PubMed  Google Scholar 

  10. Adam, M.A., K. Choudhury, P. Goffredo, S.D. Reed, D. Blazer, 3rd, S.A. Roman, and J.A. Sosa, Minimally invasive distal pancreatectomy for cancer: short-term oncologic outcomes in 1733 patients. World J Surg, 2015. 39(10): p. 2564–72.

    Article  PubMed  Google Scholar 

  11. Bilimoria, K.Y., D.J. Bentrem, A.K. Stewart, D.P. Winchester, and C.Y. Ko, Comparison of commission on cancer-approved and non-approved hospitals in the United States: implications for studies that use the National Cancer Data Base. J Clin Oncol, 2009. 27(25): p. 4177–81.

    Article  PubMed  Google Scholar 

  12. Cancer, C.o., Facility Oncology Registry Data Standards (FORDS). 2012, Chicago, IL: American College of Surgeons.

    Google Scholar 

  13. Census, U., Statistical groupings of states and counties. 2010.

    Google Scholar 

  14. Deyo, R.A., D.C. Cherkin, and M.A. Ciol, Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol, 1992. 45(6): p. 613–9.

    Article  CAS  PubMed  Google Scholar 

  15. AJCC Cancer Staging Manual. 7 ed. 2010, Chicago, IL: Springer.

  16. Tran Cao, H.S., N. Lopez, D.C. Chang, A.M. Lowy, M. Bouvet, J.M. Baumgartner, M.A. Talamini, and J.K. Sicklick, Improved perioperative outcomes with minimally invasive distal pancreatectomy: results from a population-based analysis. JAMA Surg, 2014. 149(3): p. 237–43.

    Article  PubMed  Google Scholar 

  17. Mehrabi, A., M. Hafezi, J. Arvin, M. Esmaeilzadeh, C. Garoussi, G. Emami, J. Kossler-Ebs, B.P. Muller-Stich, M.W. Buchler, T. Hackert, and M.K. Diener, A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery, 2015. 157(1): p. 45–55.

    Article  PubMed  Google Scholar 

  18. Jusoh, A.C. and B.J. Ammori, Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc, 2012. 26(4): p. 904–13.

    Article  PubMed  Google Scholar 

  19. Venkat, R., B.H. Edil, R.D. Schulick, A.O. Lidor, M.A. Makary, and C.L. Wolfgang, Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg, 2012. 255(6): p. 1048–59.

    Article  PubMed  Google Scholar 

  20. Jin, T., K. Altaf, J.J. Xiong, W. Huang, M.A. Javed, G. Mai, X.B. Liu, W.M. Hu, and Q. Xia, A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB (Oxford), 2012. 14(11): p. 711–24.

    Article  Google Scholar 

  21. Pericleous, S., N. Middleton, S.C. McKay, K.A. Bowers, and R.R. Hutchins, Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas, 2012. 41(7): p. 993–1000.

    Article  PubMed  Google Scholar 

  22. Kooby, D.A., W.G. Hawkins, C.M. Schmidt, S.M. Weber, D.J. Bentrem, T.W. Gillespie, J.B. Sellers, N.B. Merchant, C.R. Scoggins, R.C. Martin, 3rd, H.J. Kim, S. Ahmad, C.S. Cho, A.A. Parikh, C.K. Chu, N.A. Hamilton, C.J. Doyle, S. Pinchot, A. Hayman, R. McClaine, A. Nakeeb, C.A. Staley, K.M. McMasters, and K.D. Lillemoe, A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg, 2010. 210(5): p. 779–85, 786-7.

    Article  PubMed  Google Scholar 

  23. Rehman, S., S.K. John, R. Lochan, B.C. Jaques, D.M. Manas, R.M. Charnley, J.J. French, and S.A. White, Oncological feasibility of laparoscopic distal pancreatectomy for adenocarcinoma: a single-institution comparative study. World J Surg, 2014. 38(2): p. 476–83.

    Article  CAS  PubMed  Google Scholar 

  24. Hu, M., G. Zhao, F. Wang, Z. Zhao, C. Li, and R. Liu, Laparoscopic versus open distal splenopancreatectomy for the treatment of pancreatic body and tail cancer: a retrospective, mid-term follow-up study at a single academic tertiary care institution. Surg Endosc, 2014. 28(9): p. 2584–91.

    Article  PubMed  Google Scholar 

  25. National Comprehensive Cancer Network. Pancreatic Adenocarcinoma (Version 1.2016). May 1, 2017]; Available from: https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf.

  26. Merkow, R.P., K.Y. Bilimoria, J.S. Tomlinson, J.L. Paruch, J.B. Fleming, M.S. Talamonti, C.Y. Ko, and D.J. Bentrem, Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg, 2014. 260(2): p. 372–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Olga Kantor and Darren S. Bryan both contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, University of Chicago, Chicago, IL, USA

    Olga Kantor, Darren S. Bryan & Waseem Lutfi

  2. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Mark S. Talamonti, David J. Winchester, Richard A. Prinz & Marshall S. Baker

  3. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Mark S. Talamonti, David J. Winchester, Richard A. Prinz & Marshall S. Baker

  4. Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA

    Susan Sharpe

Authors
  1. Olga Kantor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Darren S. Bryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark S. Talamonti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Waseem Lutfi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Susan Sharpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David J. Winchester
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard A. Prinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marshall S. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Kantor, Lutfi, and Baker performed data collection and statistical analysis. Bryan, Kantor, and Baker performed initial manuscript drafting and critical revisions. All authors reviewed and approved the final manuscript for publication.

Corresponding author

Correspondence to Marshall S. Baker.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kantor, O., Bryan, D.S., Talamonti, M.S. et al. Laparoscopic Distal Pancreatectomy for Cancer Provides Oncologic Outcomes and Overall Survival Identical to Open Distal Pancreatectomy. J Gastrointest Surg 21, 1620–1625 (2017). https://doi.org/10.1007/s11605-017-3506-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-017-3506-y

Keywords

Search

Navigation