A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients

Abstract

Background Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. Methods Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. Results Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90-day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. Conclusion LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy.

Robot-assisted distal pancreatectomy improves spleen preservation rate versus laparoscopic distal pancreatectomy for benign and low-grade malignant lesions of the pancreas

“…In our study, the RDP group showed a significantly higher SP rate (30.2%) than that of the LDP (6.8%) group in patients with benign and low-grade malignant distal (12). However, LDP still has several technical limitations, such as reduced freedom of motion and narrowed two-dimensional visualization which may impact the surgery results (6,13,14).…”

Comparison of outcomes between laparoscopic and open pancreaticoduodenectomy without radical lymphadenectomy: Results of coarsened exact matching analysis using national database systems

“…We used the largest prospective registry available for minimally invasive PD in Japan. Japan has another prospective registry of minimally invasive PDs managed by the Japanese Society for Endoscopic and Robotic Pancreatic Surgery/Japanese Society for Endoscopic Surgery/Japanese Society of Hepato‐Biliary‐Pancreatic Surgery 18 . Although its registration system differs from that of the NCD, there is an overlap in the registration of some cases.…”

Current statement and safe implementation of minimally invasive surgery in the pancreas

“…Despite this potential benefit, MIDP is only used in about one‐third of patients, according to a recent analysis of the National Surgical Quality Improvement Program (NSQIP) database 9 . In Japan, a multicenter prospective registration study including 1197 LDPs revealed that postoperative morbidity and 90‐day mortality rates after LDP were 17% and 0.3%, respectively 10 . Thus, LDPs are performed safely in Japan, especially in experienced institutions.…”

“…The laparoscopic procedure is unsuitable for the reconstruction process of LPD because of the difficulty in adjusting the axis of the forceps to adequate suturing lines of pancreatic or biliary reconstruction. 10 Immature reconstruction substantially leads to postoperative complication such as clinically relevant pancreatic fistula/anastomotic leakage, resulting in prolonged hospital stay and even surgery-related mortality. These situations also apply to OPD.…”