Surgical Endoscopy

, Volume 29, Issue 7, pp 1871–1878 | Cite as

Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment

  • Marco Braga
  • Nicolò Pecorelli
  • Denise Ferrari
  • Gianpaolo Balzano
  • Walter Zuliani
  • Renato Castoldi



Laparoscopic distal pancreatectomy (LDP) has been recently proposed as the procedure of choice for lesions of the pancreatic body and tail in experienced centres. The purpose of this study is to assess the potential advantages of LDP in a consecutive series of 100 patients.


Propensity score matching was used to identify patients for comparison between LDP and control open group. Match criteria were: age, gender, ASA score, BMI, lesion site and size, and malignancy. All patients were treated according to an early feeding recovery policy. Primary endpoint was postoperative morbidity rate. Secondary endpoints were operative time, blood transfusion, length of hospital stay (LOS), hospital costs, and quality of life.


Thirty patients of the LDP group had pancreatic adenocarcinoma. Conversion to open surgery was necessary in 23 patients. Mean operative time was 29 min shorter in the open group (p = 0.002). No significant difference between groups was found in blood transfusion rate and postoperative morbidity rate. LDP was associated with an early postoperative rehabilitation and a shorter LOS in uneventful patients. Economic analysis showed € 775 extra cost per patient of the LDP group. General health perception and vitality were better in the LDP group one month after surgery.


Laparoscopic distal pancreatectomy improved short-term postoperative recovery and quality of life in a consecutive series of both cancer and non-cancer patients. Despite the extra cost, the laparoscopic approach should be considered the first option in patients undergoing distal pancreatectomy.


Pancreatic cancer Pancreatectomy Quality of Life Costs Laparoscopy 



Drs. Marco Braga, Nicolò Pecorelli, Denise Ferrari, Gianpaolo Balzano, Walter Zuliani, Renato Castoldi have no conflicts of interest or financial ties to disclose.


  1. 1.
    Vezakis A, Davides D, Larvin M, McMahon MJ (1999) Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 13:26–29PubMedCrossRefGoogle Scholar
  2. 2.
    Fernandez-Cruz L, Saenz A, Astudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S (2002) Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg 26:1057–1065PubMedCrossRefGoogle Scholar
  3. 3.
    Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF, Goergen M, Ceuterick M, Melotti GL, Van Nieuwenhove Y, Dallemagne B, Adham M, De La Roche E, Hesse U, Ysebaert D, Chapelle T, Roeyen G, Aerts R, Closset J, El Nakadi I, Gelin M, Millat B, Borie F, Arvieux C, Faucheron JL, Letoublon C, Bertrand C, De Roden ADN, Navez B, Staudt JP, Dabrowski A, Hansson BME, Gouillat C, Marescaux J, Sastre B, Beguin C (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137(6):597–605PubMedCrossRefGoogle Scholar
  4. 4.
    Cuschieri A, Jakimowicz JJ, van Spreeuwel J (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223:280–285PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120(6):1051–1054PubMedCrossRefGoogle Scholar
  6. 6.
    Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8:493–501PubMedCrossRefGoogle Scholar
  7. 7.
    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(1):77–82PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Seo DW, Lee SS, Park do H, Han DJ (2011) Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 25(10):3364–3372PubMedCrossRefGoogle Scholar
  9. 9.
    Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(5):779–785PubMedCrossRefGoogle Scholar
  10. 10.
    Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (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(6):1048–1059PubMedCrossRefGoogle Scholar
  11. 11.
    Pericleous S, Middleton N, McKay SC, Bowers KA, Hutchins RR (2012) Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas 41(7):993–1000PubMedCrossRefGoogle Scholar
  12. 12.
    Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci 20(4):421–428PubMedCrossRefGoogle Scholar
  13. 13.
    Hill J, Reiter J (2006) Interval estimation for treatment effects using propensity score matching. Stat Med 25:2230–2256PubMedCrossRefGoogle Scholar
  14. 14.
    Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V (2008) Effect of hospital volume on the outcome of pancreaticoduodenectomy in Italy. Br J Surg 95:357–362PubMedCrossRefGoogle Scholar
  15. 15.
    Braga M, Frasson M, Zuliani W, Vignali A, Pecorelli N, Di Carlo V (2010) Randomized clinical trial of laparoscopic versus open left colonic resection. Br J Surg 97:1180–1186PubMedCrossRefGoogle Scholar
  16. 16.
    Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce AA, Di Carlo V (2008) Fast-track recovery programme after pancreatico-duodenectomy reduces delayed gastric emptying. Br J Surg 95:1387–1393PubMedCrossRefGoogle Scholar
  17. 17.
    Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L (2001) Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet 358:1487–1492PubMedCrossRefGoogle Scholar
  18. 18.
    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
  19. 19.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Ware JE, Kosinski M, Dewey JE, Gandek B (2001) How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Quality Metric Inc., LincolnGoogle Scholar
  22. 22.
    Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Balzano G, Zerbi A, Cristallo M, Di Carlo V (2005) The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg 9(6):837–842PubMedCrossRefGoogle Scholar
  24. 24.
    Montorsi M, Zerbi A, Bassi C, Capussotti L, Coppola R, Sacchi M, Italian Tachosil Study Group (2012) Efficacy of an absorbable fibrin sealant patch (TachoSil) after distal pancreatectomy: a multicenter, randomized, controlled trial. Ann Surg 256(5):853–859; discussion 859–860.Google Scholar
  25. 25.
    Braga M, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di Carlo V (2012) Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updates Surg 64(3):179–183PubMedCrossRefGoogle Scholar
  26. 26.
    Velanovich V (2006) Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 10(1):95–98PubMedCrossRefGoogle Scholar
  27. 27.
    Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW (2008) Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc 22(5):1334–13308PubMedCrossRefGoogle Scholar
  28. 28.
    Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RCG, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248(3):438–446PubMedGoogle Scholar
  29. 29.
    Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA, Sprangers MA, Cuesta MA, Bemelman WA, LAFA study group (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254(6):868–875PubMedCrossRefGoogle Scholar
  30. 30.
    Patterson EJ, Gagner M, Salky B, Inabnet 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
  31. 31.
    Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236:149–158PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 30(377):1514–1522CrossRefGoogle Scholar
  33. 33.
    Limongelli P, Belli A, Russo G, Cioffi L, D’Agostino A, Fantini C, Belli G (2012) Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis. Surg Endosc 26(7):1830–1836PubMedCrossRefGoogle Scholar
  34. 34.
    Abu Hilal M, Hamdan M, Di Fabio F, Pearce NW, Johnson CD (2012) Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg Endosc 26(6):1670–1674PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Marco Braga
    • 1
  • Nicolò Pecorelli
    • 1
  • Denise Ferrari
    • 1
  • Gianpaolo Balzano
    • 1
  • Walter Zuliani
    • 1
  • Renato Castoldi
    • 1
  1. 1.Department of Surgery, San Raffaele HospitalVita-Salute San Raffaele UniversityMilanItaly

Personalised recommendations