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Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients

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Abstract

Background

Laparoscopy is widely accepted as a feasible option for distal pancreatectomy. However, the experience in laparoscopic distal pancreatectomy (LDP) for pancreatic ductal adenocarcinoma (PDAC) is limited to a small number of studies, reported by expert centers. The present study aimed to evaluate perioperative and oncological outcomes after LDP for PDAC in a large, multicenter cohort of patients.

Methods

A retrospective analysis of the data on 196 patients with histologically verified PDAC, operated at Oslo University Hospital—Rikshospitalet (Oslo, Norway), Asan Medical Center (Seoul, Republic of Korea), Institut Mutualiste Montsouris (Paris, France) and University Hospital Southampton (Southampton, UK) between January 2002 and April 2015 was conducted. The patients with standard (SLDP) and extended (i.e., en bloc with adjacent organ, ELDP) resections were compared in terms of perioperative and oncological outcomes.

Results

Out of 196 LDP procedures, 191 (97.4 %) were completed through laparoscopy, while five (2.6 %) were converted to open surgery. ELDP was performed in 30 (15.7 %) cases. Sixty-one (31.9 %) patients experienced postoperative complications, including 48 (25.1 %) with pancreatic fistula. The rate of clinically relevant fistula (grade B/C) was 15.7 %. Median postoperative hospital stay was 8 (2–63) days. Median follow-up was 16 months. Median survival was 31.3 months (95 % CI 22.9–39.6). Three- and 5-year actuarial survival rates were 42.4 and 30 %, respectively. SLDP was associated with significantly higher survival compared with ELDP (p = 0.032).

Conclusions

LDP seems to be a feasible and safe procedure, providing satisfactory oncological outcomes in patients with PDAC.

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Authors and Affiliations

  1. The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway

    Mushegh A. Sahakyan, Airazat M. Kazaryan, Mark Shmavonyan & Bjørn Edwin

  2. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway

    Mushegh A. Sahakyan, Mark Shmavonyan, Trond Buanes & Bjørn Edwin

  3. Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia

    Mushegh A. Sahakyan

  4. Department of Surgery, Finnmark Hospital, Kirkenes, Norway

    Airazat M. Kazaryan

  5. University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Majd Rawashdeh & Mohammad Abu Hilal

  6. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France

    David Fuks & Brice Gayet

  7. Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France

    David Fuks & Brice Gayet

  8. Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway

    Sven-Petter Haugvik, Knut Jørgen Labori, Trond Buanes, Bård Ingvald Røsok & Bjørn Edwin

  9. Department of Surgery, Vestre Viken Hospital Trust, Drammen, Norway

    Sven-Petter Haugvik

  10. Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway

    Dejan Ignjatovic

  11. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea

    Song Cheol Kim

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  1. Mushegh A. Sahakyan
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  2. Airazat M. Kazaryan
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Correspondence to Mushegh A. Sahakyan.

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Mushegh A. Sahakyan, Airazat M. Kazaryan, Majd Rawashdeh, David Fuks, Mark Shmavonyan, Sven-Petter Haugvik, Knut-Jørgen Labori, Trond Buanes, Bård Ingvald Røsok, Dejan Ignjatovic, Mohammad Abu Hilal, Brice Gayet, Song Cheol Kim and Bjørn Edwin have no conflicts of interest or financial ties to disclose.

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Sahakyan, M.A., Kazaryan, A.M., Rawashdeh, M. et al. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg Endosc 30, 3409–3418 (2016). https://doi.org/10.1007/s00464-015-4623-x

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