Surgery Today

, Volume 49, Issue 5, pp 394–400 | Cite as

Laparoscopic versus open distal pancreatectomy for benign and low-grade malignant lesions of the pancreas: a single-center comparative study

  • Ippei MatsumotoEmail author
  • Keiko Kamei
  • Shumpei Satoi
  • Takaaki Murase
  • Masataka Matsumoto
  • Kohei Kawaguchi
  • Yuta Yoshida
  • Toshimitsu Iwasaki
  • Atsushi Takebe
  • Takuya Nakai
  • Yoshifumi Takeyama
Original Article



The purpose of the study was to compare the outcomes of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign and low-grade malignant lesions to determine the safety and efficacy of LDP.


This retrospective comparative study included 67 consecutive patients who underwent LDP (n = 32) and ODP (n = 35) for benign or low-grade malignant lesions of the pancreas from January 2012 to March 2017. Thirty-five patients who were eligible for LDP in the ODP group were carefully selected. The clinical outcomes were compared in an intention-to-treat analysis.


LDP was associated with significantly less operative blood loss (182 ± 232 vs. 505 ± 376 ml, P < 0.001) but a longer operation time (327 ± 89 vs. 173 ± 48 min, P < 0.001), than ODP. There were no significant differences between the 2 groups in the overall morbidity rates defined by Clavien–Dindo classification ≥ grade II (13% vs. 11%), clinically relevant postoperative pancreatic fistula rates (6% vs. 9%), and lengths of postoperative hospital stay (11 vs. 11 days).


The study showed that LDP was safe and feasible. LDP should be considered as the first-line treatment for benign and low-grade malignant lesions in the left side of the pancreas.


Laparoscopic distal pancreatectomy Laparoscopic pancreatectomy: benign and low-grade malignant lesions 



No grant support was provided for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Cuschieri A, Jakimowicz JJ, van Spreeuwel J. Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg. 1996;223:280–5.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc. 2008;22:1334–8.CrossRefPubMedGoogle Scholar
  3. 3.
    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
  4. 4.
    Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, et al. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg. 2010;145:616–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Mehta SS, Doumane G, Mura T, Nocca D, Fabre JM. Laparoscopic versus open distal pancreatectomy: a single-institution case-control study. Surg Endosc. 2012;26:402–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Khaled YS, Malde DJ, Packer J, De Liguori Carino N, Deshpande R, O’Reilly DA, et al. A case-matched comparative study of laparoscopic versus open distal pancreatectomy. Surg Laparosc Endosc Percutan Tech. 2015;25:363–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Braga M, Pecorelli N, Ferrari D, Balzano G, Zuliani W, Castoldi R. Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment. Surg Endosc. 2015;29:1871–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M, et al. Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci. 2015;22:731–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Wellner UF, Lapshyn H, Bartsch DK, Mintziras I, Hopt UT, Wittel U, et al. Laparoscopic versus open distal pancreatectomy-a propensity score-matched analysis from the German StuDoQ|Pancreas registry. Int J Colorectal Dis. 2017;32:273–80.CrossRefPubMedGoogle Scholar
  10. 10.
    Nakamura M, Nakashima H. Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci. 2013;20:421–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery. 2015;157:45–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Ricci C, Casadei R, Taffurelli G, Toscano F, Pacilio CA, Bogoni S, et al. Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. J Gastrointest Surg. 2015;19:770–81.CrossRefGoogle Scholar
  13. 13.
    Yi X, Chen S, Wang W, Zou L, Diao D, Zheng Y, et al. 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. 2017;27:206–19.CrossRefPubMedGoogle Scholar
  14. 14.
    Cesaretti M, Bifulco L, Costi R, Zarzavadjian Le Bian A. Pancreatic resection in the era of laparoscopy: state of art. A systematic review. Int J Surg. 2017;44:309–16.CrossRefPubMedGoogle Scholar
  15. 15.
    Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR, et al. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev. 2016;4:CD011391.PubMedGoogle Scholar
  16. 16.
    Edwin B, Sahakyan MA, Abu Hilal M, 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;31:2023–41.CrossRefGoogle Scholar
  17. 17.
    Aly MY, Tsutsumi K, Nakamura M, Sato N, Takahata S, Ueda J, et al. Comparative study of laparoscopic and open distal pancreatectomy. J Laparoendosc Adv Surg Tech A. 2010;20:435–40.CrossRefPubMedGoogle Scholar
  18. 18.
    Matsumoto T, Shibata K, Ohta M, Iwaki K, Uchida H, Yada K, et al. Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech. 2008;18:340–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Matsumoto I, Takeyama Y, Kamei K, Satoi S, Nakata Y, Ishikawa H, et al. Transpancreatic mattress suture with vicryl mesh around the stump during distal pancreatectomy: a novel technique for preventing postoperative pancreatic fistula. J Am Coll Surg. 2016;223:e1–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.CrossRefGoogle Scholar
  22. 22.
    Zhang M, Fang R, Mou Y, Chen R, Xu X, Zhang R, et al. LDP vs ODP for pancreatic adenocarcinoma: a case matched study from a single-institution. BMC Gastroenterol. 2015;15:182.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, et al. Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg. 2018. Scholar
  24. 24.
    Kawai M, Hirono S, Okada KI, Satoi S, Yanagimoto H, Kon M, et al. Reinforced staplers for distal pancreatectomy. Langenbecks Arch Surg. 2017;402:1197–204.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Ippei Matsumoto
    • 1
    Email author
  • Keiko Kamei
    • 1
  • Shumpei Satoi
    • 1
  • Takaaki Murase
    • 1
  • Masataka Matsumoto
    • 1
  • Kohei Kawaguchi
    • 1
  • Yuta Yoshida
    • 1
  • Toshimitsu Iwasaki
    • 1
  • Atsushi Takebe
    • 1
  • Takuya Nakai
    • 1
  • Yoshifumi Takeyama
    • 1
  1. 1.Department of SurgeryKindai University Faculty of MedicineOsakasayamaJapan

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