Advertisement

Journal of Gastrointestinal Surgery

, Volume 14, Issue 11, pp 1804–1812 | Cite as

Laparoscopic Distal Pancreatectomy Offers Shorter Hospital Stays with Fewer Complications

  • Joseph DiNorcia
  • Beth A. Schrope
  • Minna K. Lee
  • Patrick L. Reavey
  • Sarah J. Rosen
  • James A. Lee
  • John A. Chabot
  • John D. Allendorf
2010 SSAT Poster Presentation

Abstract

Background

Laparoscopic distal pancreatectomy (LDP) is increasingly performed for lesions of the body and tail of the pancreas. The aim of this study was to investigate short-term outcomes after LDP compared to open distal pancreatectomy (ODP) at a single, high-volume institution.

Methods

We reviewed records of patients who underwent distal pancreatectomy (DP) and compared perioperative data between LDP and ODP. Continuous variables were compared using Student’s t or Wilcoxon rank-sum tests. Categorical variables were compared using chi-square or Fisher’s exact test.

Results

A total of 360 patients underwent DP. Beginning in 2001, 95 were attempted, and 71 were completed laparoscopically with a 25.3% conversion rate. Compared to ODP, LDP had similar rates of splenic preservation, pancreatic fistula, and mortality. LDP had lower blood loss (150 vs. 900 mL, p < 0.01), smaller tumor size (2.5 vs. 3.6 cm, p < 0.01), and shorter length of resected pancreas (7.7 vs. 10.0 cm, p < 0.01). LDP had fewer complications (28.2% vs. 43.8%, p = 0.02) as well as shorter hospital stays (5 vs. 6 days, p < 0.01).

Conclusions

LDP can be performed safely and effectively in patients with benign or low-grade malignant neoplasms of the distal pancreas. When feasible in selected patients, LDP offers fewer complications and shorter hospital stays.

Keywords

Distal pancreatectomy Laparoscopic distal pancreatectomy Open distal pancreatectomy 

Notes

Acknowledgements

This work was generously supported by the Doris Duke Charitable Foundation, an institutional Ruth L. Kirschstein National Research Service Award (T32 HL 007854 14), and the I.W. Foundation.

References

  1. 1.
    Cuschieri A. Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 1994;39:178–184.PubMedGoogle Scholar
  2. 2.
    Soper NJ, Brunt LM, Dunnegan DL, Meininger TA. Laparoscopic distal pancreatectomy in the porcine model. Surg Endosc 1994;8:57–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994;8:408–410.CrossRefPubMedGoogle Scholar
  4. 4.
    Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors. Surgery 1996;120:1051–1054.CrossRefPubMedGoogle Scholar
  5. 5.
    Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D. Laparoscopic pancreatic resection: single-institution experience of 19 patients. JAMA 2001;193(3):281–287.Google Scholar
  6. 6.
    Fernández-Cruz L, Saenz A, Austudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S. Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumours. World J Surg 2002;26:1057–1065.CrossRefPubMedGoogle Scholar
  7. 7.
    Shimuzu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K. Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 2004;18:402–406.CrossRefGoogle Scholar
  8. 8.
    Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E. Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 2004;18:407–411.CrossRefPubMedGoogle Scholar
  9. 9.
    Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 2005;19:1028–1034.CrossRefPubMedGoogle Scholar
  10. 10.
    Mabrut JY, Fernández-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF. Laparoscopic pancreatic resection: Results of a multicenter European study of 127 patients. Surgery 2005;137:597–605.CrossRefPubMedGoogle Scholar
  11. 11.
    Velanovich V. Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 2006;10(1):95–98.CrossRefPubMedGoogle Scholar
  12. 12.
    Corcione F, Marzano E, Cuccurullo D, Caracino V, Pirozzi F, Settembre A. Distal pancreas surgery: outcome for 19 cases managed with a laparoscopic approach. Surg Endosc 2006;20:1729–1732.CrossRefPubMedGoogle Scholar
  13. 13.
    Borja-Cacho D, Al-Refaie WB, Vickers SM, Tuttle TM, Jensen EH. Laparoscopic distal pancreatectomy. J Am Coll Surg 2009;209:758–765.CrossRefPubMedGoogle Scholar
  14. 14.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244:931–939.CrossRefPubMedGoogle Scholar
  15. 15.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Palanivelu C, Shetty R, Jani K, Sendhilkumar K, Rajan PS, Maheshkumar GS. Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center. Surg Endosc 2007;21(3):373–377.CrossRefPubMedGoogle Scholar
  17. 17.
    Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc 2008;22(5):1334–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Nakamura Y, Uchida E, Aimoto T, Matsumoto S, Yoshida H, Tajiri T. Clinical outcome of laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Surg 2009;16:35–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ. Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 2008;22:2261–2268.CrossRefPubMedGoogle Scholar
  20. 20.
    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. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 2008;248:438–443.PubMedGoogle Scholar
  21. 21.
    Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P. Laparoscopic distal pancreatectomy: Results on a consecutive series of 58 patients. Ann Surg 2007;246:77–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Cunha AS, Rault A, Beau C, Laurent C, Collet D, Masson B. A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 2008;143:289–295.CrossRefGoogle Scholar
  23. 23.
    Taylor C, O’Rourke N, Nathanson L, Martin I, Hopkins G, Layani L, Ghusn M, Fielding G. Laparoscopic distal pancreatectomy: the Brisbane experience of forty-six cases. HPB 2008;10:38–42.CrossRefPubMedGoogle Scholar
  24. 24.
    Khanna A, Koniaris LG, Nakeeb A, Schoeniger LO. Laparoscopic spleen-preserving distal pancreatectomy. J Gastrointest Surg 2005;9:733–738.CrossRefPubMedGoogle Scholar
  25. 25.
    Pryor A, Means JR, Pappas TN. Laparoscopic distal pancreatectomy with splenic preservation. Surg Endosc 2007;21:2326–2330.CrossRefPubMedGoogle Scholar
  26. 26.
    Bruzoni M, Sasson AR. Open and laparoscopic spleen-preserving, splenic vessel-preserving distal pancreatectomy: indications and outcomes. J Gastrointest Surg 2008;12:1202–1206.CrossRefPubMedGoogle Scholar
  27. 27.
    Shoup M, Brennan MF, McWhite K, Leung DHY, Klimstra D, Conlon KC. The value of splenic preservation with distal pancreatectomy. Arch Surg 2002;137:164–168.CrossRefPubMedGoogle Scholar
  28. 28.
    Richardson DQ, Scott-Conner CE. Distal pancreatectomy with and without splenectomy: a comparative study. Am Surg 1989; 55:21–25.PubMedGoogle Scholar
  29. 29.
    Aldridge MC, Williamson RCN. Distal pancreatectomy with and without splenectomy. Br J Surg 1991; 78:976–979.CrossRefPubMedGoogle Scholar
  30. 30.
    Benoist S, Dugue L, Sauvanet A, Valverde A, Mauvais F, Paye F, Farges O, Belghiti J. Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 1999;188(3):255–260.CrossRefPubMedGoogle Scholar
  31. 31.
    Fernández-Cruz L, Blanco L, Cosa R, Rendón H. Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors? World J Surg 2008;32:904–917.CrossRefPubMedGoogle Scholar
  32. 32.
    Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, Eagon JC, Brunt LM, Frisella MM, Matthews BD. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 2007;21(4):579–586.CrossRefPubMedGoogle Scholar
  33. 33.
    Sperti C, Pasquali C, Pedrazzoli S. Ductal adenocarcinoma of the body and tail of the pancreas. J Am Coll Surg 1997;185:267–271.Google Scholar
  34. 34.
    Matsumoto T, Shibata K, Ohta M, Iwaki K, Uchida H, Yada K, Mori M, Kitano S. Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech 2008;18:340–343.CrossRefPubMedGoogle Scholar
  35. 35.
    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. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 2010;210:779–785.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Joseph DiNorcia
    • 1
  • Beth A. Schrope
    • 1
  • Minna K. Lee
    • 1
  • Patrick L. Reavey
    • 1
  • Sarah J. Rosen
    • 1
  • James A. Lee
    • 1
  • John A. Chabot
    • 1
  • John D. Allendorf
    • 1
    • 2
  1. 1.College of Physicians and Surgeons, Department of SurgeryColumbia UniversityNew YorkUSA
  2. 2.New YorkUSA

Personalised recommendations