Surgical Endoscopy

, Volume 22, Issue 10, pp 2261–2268 | Cite as

Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution

  • Song C. Kim
  • Kwan T. Park
  • Ji W. Hwang
  • Hyeng C. Shin
  • Sang S. Lee
  • Dong W. Seo
  • Sung K. Lee
  • Myung H. Kim
  • Duck J. Han
Article

Abstract

Background

Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic distal pancreatic resection (LDPR) with open distal pancreatic resection (ODPR). This study aimed to compare clinical outcomes for LDPR and ODPR performed at a single institution.

Methods

For this study, 93 patients with benign pancreatic disease underwent LDPR, and 35 patients with benign pancreatic disease underwent ODPR. Patient demographic characteristics, operative times, perioperative complications, length of hospital stay, and return to normal diet were compared retrospectively between the two groups.

Results

The LDPR and ODPR groups had the same demographic characteristics. The median operative time was 195 min in the LDPR group and 190 min in the ODPR group (p > 0.05). The rate of spleen preservation was higher in the LDPR group (40.8%) than in the ODPR group (5.7%) (p < 0.05) No operative mortality occurred in either group. The overall complication rate was 24.7% in the LDPR group and 29% in the ODPR group (p > 0.05). The rate of pancreas-related complications was 11.8% in the LDPR group and 17.2% in the ODPR group (p > 0.05). Pancreatic fistula developed in 8.6% of the LDPR group and in 14.3% of the ODPR group (p > 0.05). Bowel movement return to normal and resumption of normal diet were achieved 2.8 ± 1.3 days after the operation in the LDPR group and 4.5 ± 1.6 days after the operation in the ODPR group (p < 0.05). The median duration of hospital stay was 10 days for the LDPR group, which was significantly shorter than the 16 days for the ODPR group (p < 0.01).

Conclusion

The use of LDPR for benign lesions of the distal pancreas is feasible and safe. The LDPR procedure is associated with operative times and complication rates similar to those for ODPR, but LDPR has the advantages of an earlier return to normal bowel movements and normal diet and shorter hospital stays than ODPR.

Keywords

Distal pancreatic resection Laparoscopic surgery Pancreatic neoplasm 

References

  1. 1.
    Baca I, Klempa I, Gotzen V (1994) Laparoscopic pancreatocystojejunostomy without entero-entero-anastomosis. Chirurg 65:378–381PubMedGoogle Scholar
  2. 2.
    Brune IB, Schonleben K (1992) Laparoscopic side-to-side gastrojejunostomy. Chirurg 63:577–580PubMedGoogle Scholar
  3. 3.
    Cuschieri SA, Jakimowicz JJ, Stultiens G (1998) Laparoscopic infracolic approach for complications of acute pancreatitis. Semin Laparosc Surg 5:189–194PubMedGoogle Scholar
  4. 4.
    Fletcher DR, Jones RM (1992) Laparoscopic cholecystjejunostomy as palliation for obstructive jaundice in inoperable carcinoma of pancreas. Surg Endosc 6:147–149PubMedCrossRefGoogle Scholar
  5. 5.
    Shimi S, Banting S, Cuschieri A (1992) Laparoscopy in the management of pancreatic cancer: endoscopic cholecystojejunostomy for advanced disease. Br J Surg 79:317–319PubMedCrossRefGoogle Scholar
  6. 6.
    Warshaw AL, Tepper JE, Shipley WU (1986) Laparoscopy in the staging and planning of therapy for pancreatic cancer. Am J Surg 151:76–80CrossRefGoogle Scholar
  7. 7.
    Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, Eagon JC, Brunt LM, Frisella MM, Matthews BD (2007) Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 21:579–586PubMedCrossRefGoogle Scholar
  8. 8.
    Tang CN, Tsui KK, Ha JPY, Wong DCT, Li MKW (2007) Laparoscopic distal pancreatectomy: a comparative study. Hepatogastroenterol 54:265–271Google Scholar
  9. 9.
    Teh SH, Tseng D, Sheppard BC (2007) Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J Gastrointest Surg 11:1120–1125PubMedCrossRefGoogle Scholar
  10. 10.
    Velanovich V (2006) Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 10:95–98PubMedCrossRefGoogle Scholar
  11. 11.
    Sarr MG, Pancreatic Surgery Group (2003) The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg 196:556–564PubMedCrossRefGoogle Scholar
  12. 12.
    Velanovich V (2007) The use of tissue sealant to prevent fistula formation after laparoscopic distal pancreatectomy. Surg Endosc 21:1222–1225PubMedCrossRefGoogle Scholar
  13. 13.
    Velanovich V (2006) The lasso technique for laparoscopic distal pancreatectomy. Surg Endosc 20:1766–1771PubMedCrossRefGoogle Scholar
  14. 14.
    Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553PubMedGoogle Scholar
  15. 15.
    Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054PubMedCrossRefGoogle Scholar
  16. 16.
    Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82PubMedCrossRefGoogle Scholar
  17. 17.
    Assalia A, Gagner M (2004) Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg 28:1239–1247PubMedCrossRefGoogle Scholar
  18. 18.
    Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 19:1028–1034PubMedCrossRefGoogle Scholar
  19. 19.
    Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18:407–411PubMedCrossRefGoogle Scholar
  20. 20.
    Lo CY, Chan WF, Lo CM, Fan ST, Tam PK (2004) Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 18:297–302PubMedCrossRefGoogle Scholar
  21. 21.
    Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605PubMedCrossRefGoogle Scholar
  22. 22.
    Palanivelu C, Shetty R, Jani K, Sendhilkumar K, Rajan PS, Maheshkumar GS (2007) Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center. Surg Endosc 21:373–377PubMedCrossRefGoogle Scholar
  23. 23.
    Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236:149–158PubMedCrossRefGoogle Scholar
  24. 24.
    Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K (2004) Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 18:402–406PubMedCrossRefGoogle Scholar
  25. 25.
    Stoker ME, Vose J, O’Mara P, Maini BS (1992) Laparoscopic cholecystectomy: a clinical and financial analysis of 280 operations. Arch Surg 127:1018–1024Google Scholar
  26. 26.
    Sussman LA, Christie R, Whittle DE, Sussman LA, Christie R, Whittle DE (1996) Laparoscopic excision of distal pancreas including insulinoma. ANZ J Surg 66:414–416CrossRefGoogle Scholar
  27. 27.
    Han HS, Min SK, Lee HK, Kim SW, Park YH (2005) Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign pancreas neoplasm. Surg Endosc 19:1367–1369PubMedCrossRefGoogle Scholar
  28. 28.
    Patterson EJ, Gagner M, Salky B, Inabet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D (2001) Laparoscopic pancreatic resection: single-institution experience of 19 patients. J Am Coll Surg 193:281–287PubMedCrossRefGoogle Scholar
  29. 29.
    Barlehner E, Anders S, Schwetling R (2002) Laparoscopic resection of the left pancreas: technique and indication. Dig Surg 19:507–510PubMedCrossRefGoogle Scholar
  30. 30.
    Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698PubMedCrossRefGoogle Scholar
  31. 31.
    Corcione F, Marzano E, Cuccurullo D, Caracino V, Pirozzi F, Settembre A (2006) Distal pancreas surgery: outcome for 19 cases managed with a laparoscopic approach. Surg Endosc 20:1729–1732PubMedCrossRefGoogle Scholar
  32. 32.
    Cuschieri A, Jakimowicz JJ, Van Spreeuwel J (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223:280–285PubMedCrossRefGoogle Scholar
  33. 33.
    Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J (2002) Is laparoscopic left pancreatic resection justified? Surg Endosc 16:1358–1361PubMedCrossRefGoogle Scholar
  34. 34.
    Santoro E, Carlini M, Carboni F (1999) Laparoscopic pancreatic surgery: indications, techniques, and preliminary results. Hepatogastroenterology 46:1174–1180PubMedGoogle Scholar
  35. 35.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Song C. Kim
    • 1
  • Kwan T. Park
    • 1
  • Ji W. Hwang
    • 1
  • Hyeng C. Shin
    • 1
  • Sang S. Lee
    • 2
  • Dong W. Seo
    • 2
  • Sung K. Lee
    • 2
  • Myung H. Kim
    • 2
  • Duck J. Han
    • 1
  1. 1.Department of SurgeryUlsan University College of Medicine and Asan Medical CenterSeoulKorea
  2. 2.Department of GastroenterologyUlsan University College of Medicine and Asan Medical CenterSeoulKorea

Personalised recommendations