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Evaluation of factors predicting loss of benefit provided by laparoscopic distal pancreatectomy compared to open approach

Abstract

Several studies showed safety and feasibility of laparoscopic distal pancreatectomy (LDP) as compared to open distal pancreatectomy (ODP). Patients who underwent LDP or ODP (2015–2019) were included. A 1:1 propensity score matching (PSM) was used to reduce the effect of treatment selection bias. Aim of this study was to identify those factors influencing the loss of benefit (defined as a significantly better outcome compared to ODP) after LDP. Overall, 387 patients underwent DP (n = 250 LDP, n = 137 ODP). After PSM, 274 patients (n = 137 LDP, n = 137 ODP) were selected. LDP was associated with reduced intraoperative blood loss (median: 200 mL vs. 250 mL, p < 0.001), decreased wound infection rate (1% vs. 9%, p = 0.044) and shorter time to functional recovery (TFR) (median: 4 days vs. 5 days, p = 0.002). Consequently, TFR > 5 days and blood loss > 250 mL were defined as loss of benefit after LDP. In the LDP group, age > 70 years [Odds Ratio (OR) 2.744, p = 0.022] and duration of surgery > 208 min (OR 2.957, p = 0.019) were predictors of TFR > 5 days and intraoperative blood loss > 250 mL, respectively. No differences in terms of TFR were found between ODP and LDP groups in patients > 70 years (p = 0.102). Intraoperative blood loss was significantly higher in the ODP group, also when the analysis was limited to surgical procedures with operative time > 208 min (p = 0.003). In conclusion, LDP seems comparable to ODP in terms of TFR in patients aged > 70 years. This finding could be helpful in the choice of the best surgical approach in elderly patients undergoing potentially challenging DPs.

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All data generated or analyzed during this study are included in this published article and its online resource files.

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Acknowledgements

The authors are grateful to Gioja Bianca Costanza Fund for supporting the PhD Scholarship of Dr Valentina Andreasi.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by SP, LC, and VA. The first draft of the manuscript was written by LC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. MF had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Massimo Falconi.

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Partelli, S., Cinelli, L., Andreasi, V. et al. Evaluation of factors predicting loss of benefit provided by laparoscopic distal pancreatectomy compared to open approach. Updates Surg (2021). https://doi.org/10.1007/s13304-021-01194-1

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Keywords

  • Laparoscopy
  • Distal pancreatectomy
  • Outcomes
  • Blood loss
  • Elderly