International Journal of Colorectal Disease

, Volume 32, Issue 2, pp 273–280 | Cite as

Laparoscopic versus open distal pancreatectomy—a propensity score-matched analysis from the German StuDoQ|Pancreas registry

  • Ulrich Friedrich Wellner
  • Hryhoriy Lapshyn
  • Detlef K. Bartsch
  • Ioannis Mintziras
  • Ulrich Theodor Hopt
  • Uwe Wittel
  • Hans-Jörg Krämling
  • Hubert Preissinger-Heinzel
  • Matthias Anthuber
  • Bernd Geissler
  • Jörg Köninger
  • Katharina Feilhauer
  • Merten Hommann
  • Luisa Peter
  • Natascha C. Nüssler
  • Thomas Klier
  • Ulrich Mansmann
  • Tobias Keck
  • The StuDoQ Pancreas study group and members of StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery (DGAV)
Original Article

Abstract

Purpose

The aim of this study was to assess intraoperative, postoperative, and oncologic outcome in patients undergoing laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for benign and malignant lesions of the pancreas.

Methods

Data from patients undergoing distal pancreatic resection were extracted from the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. After propensity score case matching, groups of LDP and ODP were compared regarding demography, comorbidities, operative details, histopathology, and perioperative outcome.

Results

At the time of data extraction, the StuDoQ|Pancreas registry included over 3000 pancreatic resections from over 50 surgical departments in Germany. Data from 353 patients undergoing ODP (n = 254) or LDP (n = 99) from September 2013 to February 2016 at 29 institutions were included in the analysis. Baseline data showed a strong selection bias in LDP patients, which disappeared after 1:1 propensity score matching. A comparison of the matched groups disclosed a significantly longer operation time, higher rate of spleen preservation, more grade A pancreatic fistula, shorter hospital stay, and increased readmissions for LDP. In the small group of patients operated for pancreatic cancer, a lower lymph node yield with a lower lymph node ratio was apparent in LDP.

Conclusions

LDP needed more time but potential advantages include increased spleen preservation and shorter hospital stay, as well as a trend for less transfusion, ventilation, and mortality. LDP for pancreatic cancer was performed rarely and will need critical evaluation in the future. Data from a prospective randomized registry trial is needed to confirm these results.

Keywords

StuDoQ|pancreas registry Laparoscopic distal pancreatectomy Open distal pancreatectomy 

Introduction

Laparoscopic techniques increasingly emerge in pancreatic surgery. In 1996, Cuschieri et al. were the first to describe LDP as a feasible procedure in a series of five consecutive patients [1]. In the following years, LDP was constantly optimized and finally established as a standard treatment mainly in high-volume centers [2, 3] in the treatment of benign, but also malignant lesions of the pancreatic corpus and tail [4, 5, 6]. Data on perioperative outcome from specialized centers as well as large-scale multicenter datasets have become available [2, 3, 4, 5, 6, 7, 8, 9, 10, 11].

The vast majority of these studies have demonstrated at least non-inferiority of LDP versus ODP with respect to perioperative outcome. Kooby et al. [12] conducted the first large scale comparison in a multicenter retrospective setting and demonstrated potential benefits of LDP such as reduction of blood loss, wound infection rates, and hospital stay. Recently, published meta-analyses confirmed these results and further identified a reduction in overall morbidity as well as faster recovery in LDP compared to ODP [4, 5]. A major drawback to these conclusions is that although there is evidence of a selection bias in LDP, most studies are not matched and prospective randomized trials are still lacking [4, 5]. Furthermore, the introduction of LDP to the treatment of malignant disease of the pancreas has raised concerns regarding oncologic safety. In this regard, a recent meta-analysis of five case-control studies disclosed comparable rates of margin negative resections and numbers of lymph nodes harvested in LDP versus ODP [13].

In the absence of prospective randomized trials, large-scale registry studies with case matching [14] are the best means to gather more evidence in this field. We aimed to assess perioperative and oncologic outcome of LDP versus ODP for benign and malignant lesions of the pancreas from the recently established StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery (DGAV).

Material and methods

The StuDoQ|Pancreas registry

StuDoQ|Pancreas is a prospectively maintained registry for pancreatic surgery established by the DGAV since September 2013 (www.dgav.de/studoq, www.en.studoq.de). It was designed for national assessment of quality and risk factors in pancreatic surgery in Germany. The informed consent and data safety concept was approved by the Society for Technology, Methods, and Infrastructure for Networked Medical Research (http://www.tmf-ev.de), and publication guidelines were established by the DGAV (http://www.dgav.de/studoq/datenschutzkonzept-und-publikationsrichtlinien.html). Data from the participating centers is prospectively entered in pseudonymized form using a browser-based tool and undergoes automatic plausibility control. Validation by cross-checking with institutional medical controlling data is part of the annual certification process. For the current study, all cases of ODP or LDP were identified from the StuDoQ|Pancreas registry and relevant demographic data, comorbidities, and information on operations, histology, and perioperative course were extracted in anonymized form for analysis.

Definitions

Distal pancreatic resection was defined as resection of the pancreatic tail with or without splenectomy. In the case of spleen preservation, splenic vessel preservation and Warshaw procedure (transection of the splenic vessels with preservation of the short gastric vessels) were distinguished. Multivisceral resection was defined as a distal pancreatic resection including more than pancreatic tail and spleen. Postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and postpancreatectomy hemorrhage (PPH) were assessed according to the International Study Group for Pancreatic Surgery (ISGPS) definition and grading system [15, 16, 17]. Intra-abdominal abscess requiring interventional drainage or reoperation, surgical site infection (CDC definition [18]), burst abdomen, reoperation, and in-hospital mortality were defined as either present or absent. Additional postoperative assessed parameters were necessity of unplanned postoperative ventilation of over 48 h, pneumonia, length of intensive care unit, and overall hospital stay as well as readmission. Overall postoperative morbidity was summarized according to the Clavien-Dindo classification (CDC) [19] as minor (CDC 1-3a), major (CDC 3b-4), and death (CDC 5).

Statistical analysis

R software version 3.01 (www.r-project.org) was used for all calculations. Statistical testing was performed with a two-sided significance level of 0.05. Scale variables were expressed as median and range and categorial parameters as absolute count and percentage. Univariate analysis was performed by the Chi-square test for categorial variables and the Mann-Whitney test for rational variables. Analysis was performed according to an “intention-to-treat” principle: laparoscopic procedures with conversion to laparotomy were assigned to the laparoscopic group. Propensity score matching was performed with the MatchIt package for R software [20] .

Results

Baseline data are summarized in Table 1. At the time of data extraction, the StuDoQ|Pancreas registry included a total of over 3000 case records from over 50 institutions. A total of 353 patients undergoing LDP (n = 99) and ODP (n = 254) at 29 surgical departments from September 2013 to February 2016 were identified. A number of LDP cases contributed per institution ranged from 1 to 36, with a median of 4.
Table 1

Baseline parameters in the unmatched and matched groups

Parameter

Condition

Total

LDP

ODP

p

n/median

%/range

n/median

%/range

n/median

%/range

Non-matched cohorts

Total

353

 

99

 

254

  

Age [years]

63

20–86

61

20–83

63

22–86

0.02

Sex

Male

180

51

37

37

143

56

< 0.01

Female

173

49

62

63

111

44

 

Diabetes mellitus

 

72

20

11

11

61

24

< 0.01

Heart insufficiency

 

53

15

9

9

44

17

0.05

ASA

ASA 1

48

14

21

21

27

11

0.04

ASA 2

178

50

50

51

128

50

ASA 3

124

35

27

27

97

38

ASA 4

3

1

1

1

2

1

Histology

PDAC

106

30

13

13

93

37

< 0.01

IPMN

40

11

17

17

23

9

NET

73

21

29

29

44

17

Other

134

38

40

40

94

37

Multivisceral resection

Yes

61

17

4

4

57

22

< 0.01

Matched cohorts

Total

 

198

 

99

 

99

  

Age [years]

 

61.5

20–84

61

20–83

62

22–84

0.55

Sex

M

74

37

37

37

37

37

1.00

 

W

124

63

62

63

62

63

BMI

kg/m2

25.2

15.57–47.4

25.3

15.57–47.4

25.1

17.28–45.91

0.68

ASA

ASA 1

38

19

21

21

17

17

0.27

 

ASA 2

97

49

50

51

47

48

 

ASA 3

61

31

27

27

34

34

 

ASA 4

2

1

1

1

1

1

Cerebrovascular disease

 

5

3

2

2

3

3

0.65

Heart insufficiency

 

21

11

9

9

12

12

0.49

Severe COPD

 

9

5

7

7

2

2

0.09

Coronary artery disease

 

19

10

8

8

11

11

0.47

Diabetes mellitus

 

26

13

11

11

15

15

0.40

PAOD

 

3

2

2

2

1

1

0.56

Liver cirrhosis

 

5

3

2

2

3

3

0.65

Pancreatic texture

Soft

102

52

51

52

51

52

0.89

 

Hard

18

9

8

8

10

10

 

Unknown

78

39

40

40

38

38

Multivisceral resection

 

6

3

4

4

2

2

0.41

L/ODP laparoscopic/open distal pancreatectomy, ASA American Society of Anesthesiologists grading, PAOD peripheral arterial occlusive disease, COPD chronic obstructive pulmonary disease, BMI body mass index

Baseline data and case matching

Selected baseline data in the unmatched cohorts is shown in Table 1. LDP patients were significantly younger by 2 years in median, and more frequently female (LDP vs ODP, 61 vs 63 years (p = 0.02) and 63 vs 44% female, p < 0.01). There was also less preoperative diabetes mellitus (LDP vs ODP, 11 vs 24%, p < 0.01) and a trend towards lower prevalence of heart failure (LDP vs ODP, 9 vs 17%, p = 0.05) in LDP patients. Likewise, ASA scores in the two groups were unbalanced (p = 0.04) with more ASA-1 and less ASA-3 in LDP. IPMN and NET were significantly more prevalent and PDAC less frequent in LDP, while multivisceral resections were far more common in the ODP group (22 vs 4%, p < 0.01), mirroring distinct indication spectra.

To control selection bias, LDP cases were matched 1:1 (n = 99 vs n = 99 ODP) by propensity score adjusting for sex, age, BMI, ASA score, heart failure, diabetes mellitus, histology, pancreatic texture (hard and soft), and multivisceral resection. In result, all baseline parameters were balanced after matching as shown in Table 1. Further analysis was carried out on the matched dataset.

Operation details are depicted in Table 2. Intraoperative conversion rate from LDP to ODP was 18%. As described, comparison was performed according to an ITT principle, with converted cases included in the LDP group. Median operation time was significantly longer in LDP versus ODP by about 40 min in median (222 vs 185 min, p < 0.01). Preservation of the spleen was more frequently intended (64 vs 33%, p < 0.01) and achieved in LDP patients in whom it was intended (76 vs 46%, p < 0.01). The Warshaw procedure (overall 22%) was more often employed in LDP (27%) than ODP (7%), constituting only a statistical trend (p = 0.10). An intraoperative red blood cell transfusion was rarely necessary and tended to be decreased with LDP (2 vs 7%, p = 0.09). Regarding factors of potential bias for postoperative complications, distribution of pancreatic texture (soft vs hard) and closure method of the pancreatic cut surface (anastomosis vs blind closure) were balanced between LDP and ODP.
Table 2

Operation details

Parameter

Condition

Total

LDP

OPD

p

n/median

%/range

n/median

%/range

n/median

%/range

n

 

198

 

99

 

99

 

Conversion

 

18

9

18

18

0

0

OP time [min]

 

200

65–512

222

70–407

185

65–512

< 0.01

Spleen preservation planned

 

96

49

63

64

33

33

< 0.01

Spleen preservation achieved

 

63

66

48

76

15

46

< 0.01

Technique of spleen preservation

Vessel preservation

49

78

35

73

14

93

0.10

 

Warshaw technique

14

22

13

27

1

7

 

Pancreatic closure

Anastomosis

28

14

15

15

13

13

0.19

 

Blind closure

135

68

62

63

73

74

 
 

Unknown

35

18

22

22

13

13

 

Pancreatic texture

Soft

102

52

51

52

51

52

0.89

 

Hard

18

9

8

8

10

10

 
 

Unknown

78

39

40

40

38

38

 

Multivisceral resection

 

6

3

4

4

2

2

0.41

Intraop RBC transfusion

 

9

5

2

2

7

7

0.09

L/ODP laparoscopic/open distal pancreatectomy, RBC red blood cells, OP operation

Postoperative outcome is illustrated in Table 3. Rates of surgical complications DGE (overall 11%), PPH (overall 8%), SSI (overall 9%), intra-abdominal abscess (overall 4%), burst abdomen (overall 2%), reoperation (overall 11%), and CDC grades were not different between LDP and ODP. There was a significantly different distribution of POPF grades in LDP and ODP due to a higher rate of POPF grade A in LDP. Unplanned ventilation and pneumonia, as well as ICU stay were not statistically different, although a trend towards reduced rates of unplanned ventilation was noted in LDP (1 vs 5%, p = 0.10). Mortality was low (overall 2%) with a trend towards lower mortality in the LDP group (0 vs 3%, p = 0.08). Overall hospital stay was significantly reduced by 3 days with LDP (10 vs 13 days, p < 0.01). On the other hand, readmission was significantly increased in the LDP group (16 vs 7%, p < 0.01). The significant difference in hospital stay persisted when cases with readmission were excluded (LDP vs ODP, 11 vs 13 days, p = 0.04).
Table 3

Perioperative outcome

Parameter

Condition

Total

LDP

OPD

p

n/median

%/range

n/median

%/range

n/median

%/range

n

 

198

 

99

 

99

 

POPF grade

No

113

57

50

51

63

64

< 0.01

 

A

43

22

27

27

16

16

 
 

B

30

15

15

15

15

15

 
 

C

12

6

7

7

5

5

 

DGE grade

No

178

90

89

90

89

90

0.95

 

A

15

8

9

9

6

6

 
 

B

4

2

0

0

4

4

 
 

C

1

1

1

1

0

0

 

PPH

No

184

93

90

91

94

95

0.25

 

A

7

4

6

6

1

1

 
 

B

3

2

1

1

2

2

 
 

C

4

2

2

2

2

2

 

CDC

None

93

47

42

42

51

52

0.30

 

Minor

83

42

46

47

37

37

 
 

Major

19

10

11

11

8

8

 
 

Mortality

3

2

0

0

3

3

 

SSI

 

17

9

10

10

7

7

0.34

Intra-abdominal abscess

 

8

4

3

3

5

5

0.47

Burst abdomen

 

4

2

1

1

3

3

0.31

Reoperation

 

21

11

12

12

9

9

0.49

Mortality

 

3

2

0

0

3

3

0.08

Unplanned ventilation

 

6

3

1

1

5

5

0.10

Pneumonia

 

9

5

4

4

5

5

0.73

ICUS

 

1

0–37

1

0–37

1

0–30

0.75

Readmission

 

23

12

16

16

7

7

< 0.01

OHS

 

11

4–75

10

4–75

13

7–68

< 0.01

L/ODP laparoscopic/open distal pancreatectomy, POPF postoperative pancreatic fistula, DGE delayed gastric emptying, PPH postpancreatectomy hemorrhage, CDC Clavien-Dindo grade, SSI surgical site infections, ICUS intensive care unit stay, OHS overall hospital stay

Measures of oncologic outcome were analyzed in the subgroup of patients with PDAC (Table 4). CA19-9 levels and T stage were balanced between the groups. The lymph node ratio was significantly higher in ODP (median 0.10 vs median 0.00, p < 0.01), and there was a trend towards higher lymph node yield in ODP (median 18 vs 12 lymph nodes, p = 0.05). Margin status was comparable in both groups (overall 88% margin negative).
Table 4

Oncologic parameters in the subgroup with pancreatic cancer

Parameter

Condition

Total

LDP

OPD

p

n/median

%/range

n/median

%/range

n/median

%/range

n

 

24

 

11

 

13

 

CA 19-9 [U/ml]

 

62

2.2–> 1000

59

7–480

76

2.2–> 1000

0.59

T stage

T1

4

17

3

27

1

8

0.20

 

T2

3

13

1

9

2

15

 
 

T3

15

63

7

64

8

62

 
 

T4

2

8

0

0

2

15

 

LN yield

 

13

3–48

12

3–24

18

11–48

0.05

LNR

 

0

0–0.4

0.00

0–0.4

0.10

0–0.3

< 0.01

Margin status

R0

21

88

10

91

11

85

0.61

 

R1

2

8

1

9

1

8

 
 

R2

1

4

0

0

1

8

 

L/ODP laparoscopic/open distal pancreatectomy, LN lymph node, LNR lymph node ratio, CA 19-9 carbohydrate antigen 19-9

Discussion

Several current studies have addressed perioperative outcome of LDP as compared to ODP indicating potential benefits of LDP such as reduction of blood loss, wound infection, time of hospital stay, and overall morbidity as well as faster recovery [2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 21, 22, 23, 24, 25]. We performed a matched comparative analysis of 99 LDP and 99 ODP performed at 29 surgical departments participating in the StuDoQ|Pancreas registry of the DGAV since September 2013. The aim of this study was to compare current practice results of LDP versus ODP in a broad multicenter setting without limiting the observation to a high-volume center surgery.

While there is abundant data on LDP from specialized centers for pancreatic surgery, few studies have evaluated LDP on the basis of unselected multiinstitutional national datasets to address the validity of results in the common practice setting. The best example for similar approaches might be the study by Adam et al. [24], who extracted hospital stay, readmission and histopathology from 535 patients with minimal invasive distal pancreatectomy from the US National Cancer Database operated from 2010 to 2011. De Rooij et al. [3] included 64 patients with LDP operated from 2005 to 2013 in 17 Dutch centers with a caseload of at least 20 pancreatoduodenectomies per year, which could be categorized as non-high-volume centers. Nakamura et al. [11] presented data from 729 LDP operated in 69 institutions from 2006 to 2013 extracted from the Japanese Society of Hepat-Biliary-Pancreatic Surgery (JHBPS).

Furthermore, interpretation of most LDP studies remains difficult due to considerable selection bias [13]. Propensity score matching has emerged as a popular method to control bias in biomedical studies [14], and was employed in our study. Comparison of baseline data in the matched dataset confirmed successful balancing of comorbidities and known risk factors.

Conversion rates from laparoscopic to laparotomy vary considerably among available studies. Most common conversion rates of high-volume studies range from 10 to 25% [4, 5, 6, 9, 21] consistent with our data indicating a conversion rate of 18%. Few authors even describe conversion rates of 0%, however, case load was small in these studies [23, 26]. A recent study analyzing Dutch nationwide data of 633 LDP and ODP patients demonstrated conversion rates of 33%, thus highlighting a discrepancy in high-volume as compared to low-volume centers [3]. Adam et al. included 1733 patients with malignant pancreatic lesions identified from the US National Cancer Data Base (NCDB) describing conversion rates of 23% [24]. Conversion was associated with higher rates of multiple comorbidities and locally advanced tumors in these patients. To control this bias, we chose an intention-to-treat analysis for comparison of laparoscopic and open technique.

The majority of the studies comparing LDP and ODP operation times showed no difference in both groups [4, 5, 9]. Few studies indicate reduced operation times in LDP patients [8, 27]. However, no intention-to-treat analysis was performed in these studies, and patients converted from LDP to ODP were analyzed in the ODP group. Two recent studies describe prolonged operation times in LDP patients [11, 23]. The authors presumed these results to be a consequence of high rates of splenic preservation. This is compatible with our data, demonstrating significantly longer operation times as well as higher spleen preservation rates in LDP.

Splenic preservation is regarded as a potential benefit of LDP, either by Warshaw technique or vessel-sparing spleen preservation [21]. However, the second approach is not recommended in patients presenting with malignant lesions due to oncologic safety considerations. Zhou et al. recently conducted an analysis of 246 patients undergoing LDP comparing postoperative outcome following Warshaw procedure or vessel-sparing spleen preservation for benign or low-grade malignant disease of the pancreas [28]. The authors observed higher rates of spleen infarction and development of perigastric varices in patients undergoing Warshaw procedures. However, this did not translate to an increase in postoperative morbidity, suggesting safety of both spleen-preserving techniques. Our study suggests that LDP is associated with higher rates of spleen preservation, with a higher rate of Warshaw procedures than ODP.

Although several attempts have been made to reduce postoperative morbidity resulting from pancreatectomy, overall complication rates remain high, also in LDP. Malleo et al. demonstrated overall postoperative morbidity in 47% of LDP patients, where 27% suffered from POPF [29]. Weber et al. identified high BMI, extensive length of pancreatic resection specimen, and estimated high blood loss to negatively impact postoperative morbidity [30]. The rates of POPF and DGE, the main contributing factors to postoperative morbidity, showed no difference in LDP compared to ODP in the recently published meta-analyses [4, 5, 6, 9]. Multiple studies indicated reduced overall postoperative complications [5, 9, 23, 27], while other high-volume series failed to show a difference [3, 6, 25]. The current study disclosed a higher rate of grade A POPF with LDP, which by definition are not clinically relevant [15]. Wound infection rates are rarely assessed by studies comparing LDP versus ODP, which is surprising, as reduction in wound infection rate is a postulated advantage of laparoscopic surgery in general. Most available studies report reduced surgical site infections with LDP [4, 5, 12], but this could not be confirmed in our study. Also, regarding blood loss following LDP, published data remains heterogeneous. Several studies demonstrate reduced blood loss following LDP [5, 11, 12, 23]. However, other multiple high-volume studies indicated comparable rates of blood loss in LDP and ODP patients [3, 6, 7, 31], consistent with our findings. The observed trends towards reduced ventilation requirements and even mortality in LDP were tempting, but not statistically significant. In summary, superiority of LDP in terms of overall and severe perioperative morbidity remains controversial.

A shorter time to recover is reflected by significantly reduced hospital stay in LDP compared to ODP, consistent with the vast majority of studies [4, 5, 7, 23, 24, 25, 31, 32]. Only few LDP studies considered readmission rates, and a recent meta-analysis did not find a significant difference in this respect [5]. However, Baker et al. [33] observed that adding readmission to the length of stay, the benefit of shorter hospital stay in LDP was lost. Our data also shows increased readmission rates with LDP. The StudoQ|Pancreas data do not record the length of hospital stay during readmission, so the analysis of pooled length of stay was not possible. Nevertheless, the significant advantage of shorter hospital stay persisted when cases with readmission were excluded in LDP and ODP. These findings might be interpreted as evidence for faster recovery in LDP, which is lost in patients with complications necessitating readmission.

In the treatment of benign pancreatic lesions, LDP has gained acceptance as a standard procedure. However, concerns have been raised regarding oncologic safety and feasibility of radical resections. One study described increased rates of margin positive resections in LDP patients [27], but case load was small. Adam et al. demonstrated comparable rates of margin positive resections in LDP versus OPD, but found increased rates of margin positive resections in patients operated in low-volume centers [21]. In recent years, more evidence has emerged from retrospective series and meta-analysis to demonstrate non-inferiority of LDP concerning rates of margin negative resections, numbers of lymph nodes harvested, and survival [2, 13, 34, 35]. Our data demonstrates comparable negative margin resection rates, but a trend for lower lymph node yield in LDP. Nevertheless, the lymph node ratio was significantly lower in LDP patients, suggesting less advanced tumors. These results must be interpreted with caution due to the small case number of LDP for PDAC. We conclude that LDP for PDAC should be critically evaluated in the future.

In conclusion, this analysis of the German StuDoQ|Pancreas registry disclosed several salient findings in the setting of current practice across unselected institutions in Germany: patients undergoing LDP represent a selected group with a younger age, predominance of female patients, and indications like IPMN and pNEN. For meaningful comparison to ODP, case matching was needed. In the matched dataset, operation times were longer, and spleen preservation was more often intended and achieved in LDP. LDP was significantly associated with shorter hospital stay, but also with increased readmission. Preliminary data on LDP for PDAC suggests that LDP be critically evaluated in this indication. As randomized trials on LDP are still lacking, the StuDoQ|Pancreas registry might be a valuable framework for prospective randomized registry trials in pancreatic surgery.

Notes

Acknowledgements

This study has been conducted using the StuDoQ|Pancreas registry provided by the Study, Documentation, and Quality Center (Studien, Dokumentations- und Qualitätszentrum, StuDoQ) of the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) with the ID StuDoQ|Pankreas-0001.

Members of the StuDoQ|Pancreas study group who contributed to this study, in order of enrolled cases:

Prof. Dr. Thomas Kraus, Allgemeine, Viszeral und Minimalinvasive Chirurgie, Nordwestkrankenhaus Frankfurt, Frankfurt, Germany

Prof. Dr. Michael Ghadimi, Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Göttingen, Germany

Prof. Dr. Carsten Gutt, Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Klinikum Memmingen, Memmingen, Germany

Prof. Dr. Thomas Manger, Abteilung für Allgemeine-, Viszeral- und Kinderchirurgie, SRH Waldklinikum Gera, Gera, Germany

Prof. Dr. Jens Werner, Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der LMU München, Klinikum Großhadern, München, Germany

Prof. Dr. Helmut Witzigmann, Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany

Prof. Dr. Christoph-Thomas Germer, Klinik & Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Würzburg, Germany

Prof. Dr. Jörg-Peter Ritz, Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Germany

Dr. Ute Tröbs, Allgemein- und Viszeralchirurgie, Kreiskrankenhaus Delitzsch, Delitzsch, Germany

Prof. Dr. Winfried Padberg, Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen Marburg Standort Gießen, Giessen, Germany

Prof. Dr. Matthias Glanemann, Klinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg an der Saar, Germany

Prof. Dr. Jörg C. Kalff, Abteilung für Viszerale/kolorektale Chirurgie und Proktologie, Universitätsklinikum Bonn, Bonn, Germany

Prof. Dr. Anton J. Kroesen, Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Krankenhaus Porz am Rhein, Köln, Germany

Prof. Dr. Pompiliu Piso, Chirurgie I, Barmherzige Brüder Regensburg, Regensburg, Germany

Prof. Dr. Stefan Post, Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany

Prof. Dr. Hans-Bernd Reith, Allgemein- und Viszeralchirurgie, Agaplesion Diakoniekliniken Kassel, Kassel, Germany

Prof. Dr. Norbert Senninger, Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster, Münster, Germany

Prof. Dr. Ernst Klar, Allgemeine-, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany

Dr. Franz-Josef Schumacher, Klinik für Allgemein- und Viszeralchirurgie, Katholische Kliniken Oberhausen, Oberhausen, Germany

Prof. Dr. Albrecht Stier, Klinik für Allgemein- und Viszeralchirurgie, Helios-Klinik Erfurt, Erfurt, Germany

Prof. Dr. Elke Wagler, Allgemein-, Visceral- und Onkochirurgie, Pleißental-Klinik GmbH, Werdau, Germany

Compliance with ethical standards

Conflict of interest

The authors are members of the German Society for General and Visceral Surgery (DGAV).

Ethical approval

For this type of study, a formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Cuschieri A, Jakimowicz JJ, van Spreeuwel J (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223:280CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kooby DA, Hawkins WG, Schmidt CM et al (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210:779–785CrossRefPubMedGoogle Scholar
  3. 3.
    de Rooij T, Jilesen AP, Boerma D et al (2015) A Nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease. J Am Coll Surg 220:263–270CrossRefPubMedGoogle Scholar
  4. 4.
    Mehrabi A, Hafezi M, Arvin J et al (2015) 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 157:45–55CrossRefPubMedGoogle Scholar
  5. 5.
    Venkat R, Edil BH, Schulick RD et al (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255:1048–1059. doi:10.1097/SLA.0b013e318251ee09 CrossRefPubMedGoogle Scholar
  6. 6.
    Pericleous S, Middleton N, McKay SC et al (2012) Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas 41:993–1000CrossRefPubMedGoogle Scholar
  7. 7.
    Shin SH, Kim SC, Song KB et al (2015) A comparative study of laparoscopic vs open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis. J Am Coll Surg 220:177–185CrossRefPubMedGoogle Scholar
  8. 8.
    Finan KR, Cannon EE, Kim EJ et al (2009) Laparoscopic and open distal pancreatectomy: a comparison of outcomes. Am Surg 75:671–680PubMedGoogle Scholar
  9. 9.
    Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepato-Biliary-Pancreat Sci 20:421–428CrossRefGoogle Scholar
  10. 10.
    Liang S, Hameed U, Jayaraman S (2014) Laparoscopic pancreatectomy: indications and outcomes. World J Gastroenterol WJG 20:14246CrossRefPubMedGoogle Scholar
  11. 11.
    Nakamura M, Wakabayashi G, Miyasaka Y, et al. (2015) Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepato-Biliary-Pancreat SciGoogle Scholar
  12. 12.
    Kooby DA, Gillespie T, Bentrem D et al (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446PubMedGoogle Scholar
  13. 13.
    Ricci C, Casadei R, Taffurelli G et al (2015) Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. J Gastrointest Surg Off J Soc Surg Aliment Tract 19:770–781. doi:10.1007/s11605-014-2721-z CrossRefGoogle Scholar
  14. 14.
    Haukoos JS, Lewis RJ (2015) The propensity score. JAMA 314:1637–1638. doi:10.1001/jama.2015.13480 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMedGoogle Scholar
  16. 16.
    Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH)—an international study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25. doi:10.1016/j.surg.2007.02.001 CrossRefPubMedGoogle Scholar
  17. 17.
    Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768CrossRefPubMedGoogle Scholar
  18. 18.
    Mangram AJ, Horan TC, Pearson ML, et al. (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) hospital infection control practices advisory committee Am J Infect Control 27:97–132; quiz 133–134; discussion 96.Google Scholar
  19. 19.
    Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. doi:10.1097/SLA.0b013e3181b13ca2 CrossRefPubMedGoogle Scholar
  20. 20.
    Ho D, Imai K, King G, Stuart E (2007) Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Polit Anal 15:199–236CrossRefGoogle Scholar
  21. 21.
    Postlewait LM, Kooby DA (2015) Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable? J Gastrointest Oncol 6:406PubMedPubMedCentralGoogle Scholar
  22. 22.
    Bausch D, Keck T (2013) Laparoscopic pancreatic resections. Langenbeck's Arch Surg 398:939–945CrossRefGoogle Scholar
  23. 23.
    Yan J, Kuang T, Ji D, et al. (2015) Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study. J Zhejiang Univ Sci B 1Google Scholar
  24. 24.
    Adam MA, Choudhury K, Goffredo P, et al. (2015) Minimally invasive distal Pancreatectomy for cancer: short-term oncologic outcomes in 1733 patients. World J Surg 1–9Google Scholar
  25. 25.
    Sharpe SM, Talamonti MS, Wang E et al (2015) The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes. Am J Surg 209:557–563CrossRefPubMedGoogle Scholar
  26. 26.
    Hilal MA, Jain G, Kasasbeh F et al (2009) Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral Centre. Surg Endosc 23:2743–2747CrossRefPubMedGoogle Scholar
  27. 27.
    DiNorcia J, Schrope BA, Lee MK et al (2010) Laparoscopic distal pancreatectomy offers shorter hospital stays with fewer complications. J Gastrointest Surg 14:1804–1812CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Zhou ZQ, Kim SC, Song KB et al (2014) Laparoscopic spleen-preserving distal pancreatectomy: comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation. World J Surg 38:2973–2979CrossRefPubMedGoogle Scholar
  29. 29.
    Malleo G, Salvia R, Mascetta G et al (2014) Assessment of a complication risk score and study of complication profile in laparoscopic distal pancreatectomy. J Gastrointest Surg 18:2009–2015CrossRefPubMedGoogle Scholar
  30. 30.
    Weber SM, Cho CS, Merchant N et al (2009) Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula. Ann Surg Oncol 16:2825–2833CrossRefPubMedGoogle Scholar
  31. 31.
    Ricci C, Casadei R, Taffurelli G et al (2015) Laparoscopic distal pancreatectomy in benign or premalignant pancreatic lesions: is it really more cost-effective than open approach? J Gastrointest Surg:1–10Google Scholar
  32. 32.
    Rutz DR, Squires MH, Maithel SK et al (2014) Cost comparison analysis of open versus laparoscopic distal pancreatectomy. HPB 16:907–914CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Baker MS, Bentrem DJ, Ujiki MB, et al. (2011) Adding days spent in readmission to the initial postoperative length of stay limits the perceived benefit of laparoscopic distal pancreatectomy when compared with open distal pancreatectomy. Am J Surg 201:295–299-300. doi:10.1016/j.amjsurg.2010.09.014
  34. 34.
    Rehman S, John S, Lochan R et al (2014) Oncological feasibility of laparoscopic distal pancreatectomy for adenocarcinoma: a single-institution comparative study. World J Surg 38:476–483CrossRefPubMedGoogle Scholar
  35. 35.
    Jayaraman S, Gonen M, Brennan MF et al (2010) Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg 211:503–509CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ulrich Friedrich Wellner
    • 1
  • Hryhoriy Lapshyn
    • 1
  • Detlef K. Bartsch
    • 2
  • Ioannis Mintziras
    • 2
  • Ulrich Theodor Hopt
    • 3
  • Uwe Wittel
    • 3
  • Hans-Jörg Krämling
    • 4
  • Hubert Preissinger-Heinzel
    • 4
  • Matthias Anthuber
    • 5
  • Bernd Geissler
    • 5
  • Jörg Köninger
    • 6
  • Katharina Feilhauer
    • 6
  • Merten Hommann
    • 7
  • Luisa Peter
    • 7
  • Natascha C. Nüssler
    • 8
  • Thomas Klier
    • 8
  • Ulrich Mansmann
    • 9
    • 10
  • Tobias Keck
    • 1
  • The StuDoQ Pancreas study group and members of StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery (DGAV)
  1. 1.Clinic for SurgeryUniversity Clinic Schleswig-HolsteinLübeckGermany
  2. 2.Department of Visceral, Thoracic and Vascular SurgeryPhilipps University MarburgMarburgGermany
  3. 3.Clinic for General and Visceral SurgeryUniversity Medical Center FreiburgFreiburgGermany
  4. 4.Department of General, Visceral and Vascular SurgeryEvangelical Hospital of DüsseldorfDüsseldorfGermany
  5. 5.Department of General, Visceral and Transplantation Surgery,Clinic AugsburgAugsburgGermany
  6. 6.Department of General, Visceral, Thoracic, and Transplantation SurgeryKatharinenhospital, Clinic StuttgartStuttgartGermany
  7. 7.Department of General and Visceral Surgery, Central Clinic Bad BerkaBad BerkaGermany
  8. 8.Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology,Clinic NeuperlachMunichGermany
  9. 9.Institute for Medical Informatics, Biometry and EpidemiologyLudwig-Maximilians-UniversityMunichGermany
  10. 10.German Cancer Consortium (DKTK)HeidelbergGermany

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