Similar articles

Abstract: Objective: To compare the peri-operative outcomes for laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign or premalignant pancreatic neoplasms in two institutions. Methods: This prospective comparative study included 91 consecutive patients who underwent LDP (n=45) or ODP (n=46) from Jan. 2010 to Dec. 2012. Demographics, intra-operative characteristics, and post-operative outcomes were compared. Results: The median operating time in the LDP group was (158.7±38.3) min compared with (92.2±24.1) min in the ODP group (P<0.001). Patients had lower blood loss in LDP than in the ODP ((122.6±61.1) ml vs. (203.1±84.8) ml, P<0.001). The rates of splenic conservation between the LDP and ODP groups were similar (53.3% vs. 47.8%, P=0.35). All spleen-preserving distal pancreatectomies were conducted with vessel preservation. LDP also demonstrated better post-operative outcomes. The time to oral intake and normal daily activities was faster in the LDP group than in the ODP group ((1.6±0.5) d vs. (3.2±0.7) d, P<0.01; (1.8±0.4) d vs. (2.1±0.6) d, P=0.02, respectively), and the post-operative length of hospital stay in LDP was shorter than that in ODP ((7.9±3.8) d vs. (11.9±5.8) d, P=0.006). No difference in tumor size ((4.7±3.2) cm vs. (4.5±1.8) cm, P=0.77) or overall pancreatic fistula rate (15.6% vs. 19.6%, P=0.62) was found between the groups, while the overall post-operative complication rate was lower in the LDP group (26.7% vs. 47.8%, P=0.04). Conclusions: LDP is safe and effective for benign or premalignant pancreatic neoplasms, featuring lower blood loss and substantially faster recovery.

腹腔镜与开腹胰体尾切除术双中心对照研究

[1]Abu Hilal, M., Jain, G., Kasasbeh, F., et al., 2009. Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre. Surg. Endosc., 23(12):2743-2747.

[2]Abu Hilal, M., Hamdan, M., Di Fabio, F., et al., 2012. Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg. Endosc., 26(6):1670-1674.

[3]Baker, M.S., Bentrem, D.J., Ujiki, M.B., et al., 2009. A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery, 146(4):635-643.

[4]Bassi, C., Dervenis, C., Butturini, G., et al., 2005. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 138(1):8-13.

[5]Butturini, G., Inama, M., Malleo, G., et al., 2012. Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis. J. Surg. Oncol., 105(4):387-392.

[6]Casadei, R., Ricci, C., D'Ambra, M., et al., 2010. Laparoscopic versus open distal pancreatectomy in pancreatic tumours: a case-control study. Updates Surg., 62(3-4):171-174.

[7]Cuschieri, A., 1994. Laparoscopic surgery of the pancreas. J. R. Coll. Surg. Edinb., 39(3):178-184.

[8]Fox, A.M., Pitzul, K., Bhojani, F., et al., 2012. Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center. Surg. Endosc., 26(5):1220-1230.

[9]Goh, B.K., Tan, Y.M., Chung, Y.F., 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.

[10]Jayaraman, S., Gonen, M., Brennan, M.F., et al., 2010. Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J. Am. Coll. Surg., 211(4):503-509.

[11]Jusoh, A.C., Ammori, B.J., 2012. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg. Endosc., 26(4):904-913.

[12]Kneuertz, P.J., Patel, S.H., Chu, C.K., et al., 2012. Laparoscopic distal pancreatectomy: trends and lessons learned through an 11-year experience. J. Am. Coll. Surg., 215(2):167-176.

[13]Kooby, D.A., Gillespie, T., Bentrem, D., et al., 2008. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann. Surg., 248(3):438-446.

[14]Lee, S.E., Jang, J.Y., Lee, K.U., et al., 2008. Clinical comparison of distal pancreatectomy with or without splenectomy. J. Korean Med. Sci., 23(6):1011-1014.

[15]Mabrut, J.Y., Fernandez-Cruz, L., Azagra, J.S., et al., 2005. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery, 137(6):597-605.

[16]Mekeel, K.L., Moss, A.A., Reddy, K.S., et al., 2011. Laparoscopic distal pancreatectomy: does splenic preservation affect outcomes? Surg. Laparosc. Endosc. Percutan. Tech., 21(5):362-365.

[17]Melotti, G., Butturini, G., Piccoli, M., et al., 2007. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann. Surg., 246(1):77-82.

[18]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.

[19]Pericleous, S., Middleton, N., McKay, S.C., et al., 2012. Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas, 41(7):993-1000.

[20]Shoup, M., Brennan, M.F., McWhite, K., et al., 2002. The value of splenic preservation with distal pancreatectomy. Arch. Surg., 137(2):164-168.

[21]Soh, Y.F., Kow, A.W., Wong, K.Y., et al., 2012. Perioperative outcomes of laparoscopic and open distal pancreatectomy: Our institution’s 5-year experience. Asian J. Surg., 35(1):29-36.

[22]Song, K.B., Kim, S.C., Park, J.B., 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.

[23]Taylor, C., O'Rourke, N., Nathanson, L., et al., 2008. Laparoscopic distal pancreatectomy: the Brisbane experience of forty-six cases. HPB (Oxford), 10(1):38-42.

[24]Venkat, R., Edil, B.H., Schulick, R.D., et al., 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.

[25]Vijan, S.S., Ahmed, K.A., Harmsen, W.S., et al., 2010. Laparoscopic vs open distal pancreatectomy: a single institution comparative study. Arch. Surg., 145(7):616-621.

[26]Warshaw, A.L., 1988. Conservation of the spleen with distal pancreatectomy. Arch. Surg., 123(5):550-553.

[27]Wente, M.N., Bassi, C., Dervenis, C., et al., 2007. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 142(5):761-768.

[28]Xie, K., Zhu, Y.P., Xu, X.W., et al., 2012. Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: a meta-analysis. World J. Gastroenterol., 18(16):1959-1967.