Skip to main content

Advertisement

SpringerLink
Log in

Impact of laparoscopy in patients aged over 70 years requiring distal pancreatectomy: a French multicentric comparative study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Few data are available concerning short-term results of minimally invasive surgery in patients > 70 years old requiring distal pancreatectomy. The aim of this study was to compare short-term results after laparoscopic (LDP) versus open distal pancreatectomy (ODP) in this subgroup of patients.

Methods

All patients > 70 years who underwent distal pancreatectomy in 3 expert centers between 1995 and 2017 were included and data were retrospectively analyzed. Demographic, intraoperative data and postoperative outcomes in LDP and ODP groups were compared.

Results

A distal pancreatectomy was performed in 109 elderly patients; LDP group included 53 patients while ODP group included 56. There were 55 (50.5%) males and 54 (49.5%) women with a median age of 75 years (range 70–87). Fifty (45.9%) patients were 70–74, 40 (36.7%) patients were 75–79, and 19 (17.4%) patients were over 80 years. Nine (8.2%) patients required conversion to open surgery. The median operative time was not different between LDP and ODP (204 vs. 220 min, p = 0.62). The intraoperative blood loss was significantly lower in the LDP group (238 ± 312 vs. 425 ± 582 ml, p = 0.009) with no difference regarding the intraoperative transfusion rate. 90-day mortality (0 vs. 5%, p = 0.42), overall complication (45.4 vs. 51.8%, p = 0.53), major complication (18.2 vs. 12.5%, p = 0.43), grade B/C pancreatic fistula (6.8 vs. 7.1%, p = 0.71), were comparable in the 2 groups. Only postoperative confusion rate was significantly lower in the LDP group (4.5 vs. 25%, p = 0.01). Median length of stay was significantly lower in the LDP group (14 ± 10 vs. 16 ± 11 days, p = 0.04). R0 resection was performed in 94% of LDP patients and 89% in ODP patients without significant difference (p = 0.73).

Conclusions

The laparoscopic approach seems to reduce blood loss, postoperative confusion, and length of stay in elderly patients requiring distal pancreatectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR et al (2016) Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev 4:CD011391

    PubMed  Google Scholar 

  2. Edwin B, Sahakyan MA, Hilal MA, Besselink MG, Braga M, Fabre JM et al.Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc. 2017

  3. Shin SH, Kim SC, Song KB, Hwang DW, Lee JH, Park KM et al (2016) Appraisal of laparoscopic distal pancreatectomy for left-sided pancreatic cancer: a large volume cohort study of 152 consecutive patients. PLoS ONE 11(9):e0163266

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. 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):421–428

    Article  PubMed  Google Scholar 

  5. Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M et al (2015) Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci 22(10):731–736

    Article  PubMed  Google Scholar 

  6. Mehta SS, Doumane G, Mura T, Nocca D, Fabre JM (2012) Laparoscopic versus open distal pancreatectomy: a single-institution case-control study. Surg Endosc 26(2):402–407

    Article  PubMed  Google Scholar 

  7. Liang S, Hameed U, Jayaraman S (2014) Laparoscopic pancreatectomy: indications and outcomes. World J Gastroenterol 20(39):14246–14254

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fong Y, Blumgart LH, Fortner JG, Brennan MF (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222(4):426–434. (discussion 34–37)

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Yeo CJ, Sohn TA, Cameron JL, Hruban RH, Lillemoe KD, Pitt HA (1998) Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 227(6):821–831

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Balcom JHT, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136(4):391–398

    Article  PubMed  Google Scholar 

  11. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J et al (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210. (discussion 210–211)

    Article  PubMed  Google Scholar 

  12. Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10(3):347–356

    Article  PubMed  Google Scholar 

  13. Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH et al (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2(3):207–216

    Article  PubMed  CAS  Google Scholar 

  14. Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D (2006) Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 10(6):813–822

    Article  PubMed  Google Scholar 

  15. Riall TS, Reddy DM, Nealon WH, Goodwin JS (2008) The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 248(3):459–467

    PubMed  PubMed Central  Google Scholar 

  16. Bathe OF, Levi D, Caldera H, Franceschi D, Raez L, Patel A et al (2000) Radical resection of periampullary tumors in the elderly: evaluation of long-term results. World J Surg 24(3):353–358

    Article  PubMed  CAS  Google Scholar 

  17. Brozzetti S, Mazzoni G, Miccini M, Puma F, De Angelis M, Cassini D et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141(2):137–142

    Article  PubMed  Google Scholar 

  18. Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P (2012) Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB 14(10):649–657

    Article  PubMed  Google Scholar 

  19. Casadei R, Ricci C, Lazzarini E, Taffurelli G, D’Ambra M, Mastroroberto M et al (2014) Pancreatic resection in patients 80 years or older: a meta-analysis and systematic review. Pancreas 43(8):1208–1218

    Article  PubMed  Google Scholar 

  20. Kawaguchi Y, Fuks D, Nomi T, Levard H, Gayet B (2015) Laparoscopic distal pancreatectomy employing radical en bloc procedure for adenocarcinoma: technical details and outcomes. Surgery 157(6):1106–1112

    Article  PubMed  Google Scholar 

  21. Sanchez-Cabus S, Adam JP, Pittau G, Gelli M, Cunha AS (2016). Laparoscopic left pancreatectomy: early results after 115 consecutive patients. Surg Endosc 30(10):4480–4488

    Article  PubMed  Google Scholar 

  22. Kimura W, Yano M, Sugawara S, Okazaki S, Sato T, Moriya T et al (2010) Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance. J Hepatobiliary Pancreat Sci 17(6):813–823

    Article  PubMed  Google Scholar 

  23. Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123(5):550–553

    Article  PubMed  CAS  Google Scholar 

  24. Strasberg SM, Linehan DC, Hawkins WG (2007) Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 204(2):244–249

    Article  PubMed  Google Scholar 

  25. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13

    Article  PubMed  Google Scholar 

  26. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25

    Article  PubMed  Google Scholar 

  27. Brouquet A, Cudennec T, Benoist S, Moulias S, Beauchet A, Penna C et al (2010) Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg 251(4):759–765

    Article  PubMed  Google Scholar 

  28. 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(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mise Y, Day RW, Vauthey JN, Brudvik KW, Schwarz L, Prakash L et al. (2015) After pancreatectomy, the “90 days from surgery” definition is superior to the “30 days from discharge” definition for capture of clinically relevant readmissions. J Gastrointest Surg 20(1):77–84

    Article  Google Scholar 

  30. Jusoh AC, Ammori BJ (2012) Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 26(4):904–913

    Article  PubMed  Google Scholar 

  31. 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):1048–1059

    Article  PubMed  Google Scholar 

  32. Sui CJ, Li B, Yang JM, Wang SJ, Zhou YM (2012) Laparoscopic versus open distal pancreatectomy: a meta-analysis. Asian J Surg 35(1):1–8

    Article  PubMed  Google Scholar 

  33. Sahakyan MA, Edwin B, Kazaryan AM, Barkhatov L, Buanes T, Ignjatovic D et al (2017) Perioperative outcomes and survival in elderly patients undergoing laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Sci 24(1):42–48

    Article  PubMed  Google Scholar 

  34. Yi X, Chen S, Wang W, Zou L, Diao D, Zheng Y et al. (2017) A systematic review and meta-analysis of laparoscopic and open distal pancreatectomy of nonductal adenocarcinomatous pancreatic tumor (NDACPT) in the pancreatic body and tail. Surg Laparosc Endosc Percutan Tech 27(4):206–219

    Article  PubMed  Google Scholar 

  35. Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW et al (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22(10):2261–2268

    Article  PubMed  Google Scholar 

  36. Teh SH, Tseng D, Sheppard BC (2007) Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J Gastrointest Surg 11(9):1120–1125

    Article  PubMed  Google Scholar 

  37. Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137(2):164–168

    Article  PubMed  Google Scholar 

  38. Kleeff J, Diener MK, Z’Graggen K, Hinz U, Wagner M, Bachmann J et al (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245(4):573–582

    Article  PubMed  PubMed Central  Google Scholar 

  39. Goh BK, Tan YM, Chung YF, Cheow PC, Ong HS, Chan WH et al (2008) Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg 143(10):956–965

    Article  PubMed  Google Scholar 

  40. Kneuertz PJ, Patel SH, Chu CK, Fisher SB, Maithel SK, Sarmiento JM et al (2012) Laparoscopic distal pancreatectomy: trends and lessons learned through an 11-year experience. J Am Coll Surg 215(2):167–176

    Article  PubMed  Google Scholar 

  41. Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB et al (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248(3):438–446

    PubMed  Google Scholar 

  42. Finlayson E, Fan Z, Birkmeyer JD (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205(6):729–734

    Article  PubMed  Google Scholar 

  43. Khan S, Sclabas G, Lombardo KR, Sarr MG, Nagorney D, Kendrick ML et al (2010) Pancreatoduodenectomy for ductal adenocarcinoma in the very elderly; is it safe and justified? J Gastrointest Surg 14(11):1826–1831

    Article  PubMed  Google Scholar 

  44. Magge D, Gooding W, Choudry H, Steve J, Steel J, Zureikat A et al (2013) Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg 148(6):525–531

    Article  PubMed  Google Scholar 

  45. Duran H, Ielpo B, Caruso R, Ferri V, Quijano Y, Diaz E et al (2014) Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot 10(3):280–285

    Article  PubMed  Google Scholar 

  46. Marangos IP, Buanes T, Rosok BI, Kazaryan AM, Rosseland AR, Grzyb K et al (2012) Laparoscopic resection of exocrine carcinoma in central and distal pancreas results in a high rate of radical resections and long postoperative survival. Surgery 151(5):717–723

    Article  PubMed  Google Scholar 

  47. Kang CM, Lee SH, Lee WJ (2014) Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: current status and future perspectives. World J Gastroenterol 20(9):2343–2351

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kang CM, Kim DH, Lee WJ (2010) Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24(7):1533–1541

    Article  PubMed  Google Scholar 

  49. Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH et al (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):3364–3372

    Article  PubMed  Google Scholar 

  50. Hu M, Zhao G, Wang F, Zhao Z, Li C, Liu R (2014) Laparoscopic versus open distal splenopancreatectomy for the treatment of pancreatic body and tail cancer: a retrospective, mid-term follow-up study at a single academic tertiary care institution. Surg Endosc 28(9):2584–2591

    Article  PubMed  Google Scholar 

  51. Sahakyan MA, Kim SC, Kleive D, Kazaryan AM, Song KB, Ignjatovic D et al. (2017) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: long-term oncologic outcomes after standard resection. Surgery 162(4):802–811

    Article  PubMed  Google Scholar 

  52. Sulpice L, Farges O, Goutte N, Bendersky N, Dokmak S, Sauvanet A et al. (2015) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: time for a randomized controlled trial? results of an all-inclusive national observational study. Ann Surg 262(5):868–873. (discussion 73–74)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery and Transplantation, Centre hospital-universitaire, Université de Montpellier- Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France

    Regis Souche, Astrid Herrero, Françoise Guillon, Isabelle Pirlet, Frederic Borie & Jean-Michel Fabre

  2. Department of Digestive Surgery, Institut Mutualiste Montsouris, Faculté Paris Descartes, 15 rue de l’Ecole de Médecine, 75005, Paris, France

    David Fuks, Thierry Perniceni & Brice Gayet

  3. Department of Hepatobiliary and Liver transplantation, Centre hépato-biliaire Paul Brousse, Villejuif. Université Paris-Sud, 63 rue Gabriel Péri, 94276, Le krelin-Bicetre cedex, France

    Julie Perinel & Antonio Sa Cunha

  4. Digestive and Mini-invasive Surgery unit, Department of digestive surgery and transplantation, St Eloi Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France

    Regis Souche

Authors
  1. Regis Souche
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie Perinel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Astrid Herrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Françoise Guillon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Isabelle Pirlet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thierry Perniceni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frederic Borie
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Sa Cunha
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Brice Gayet
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jean-Michel Fabre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Regis Souche.

Ethics declarations

Disclosure

Drs Souche, Fuks, Perinel, Herrero, Guillon, Pirlet, Perniceni, Borie, Sa Cunha, Gayet, and Fabre have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Souche, R., Fuks, D., Perinel, J. et al. Impact of laparoscopy in patients aged over 70 years requiring distal pancreatectomy: a French multicentric comparative study. Surg Endosc 32, 3164–3173 (2018). https://doi.org/10.1007/s00464-018-6033-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6033-3

Keywords

Search

Navigation