Clinical outcomes compared between laparoscopic and open distal pancreatectomy

Eom, Bang Wool; Jang, Jin–Young; Lee, S. E.; Han, Ho Seong; Yoon, Yoo‐Seok; Kim, S.-W.

doi:10.1007/s00464-007-9660-7

Cited by 129 publications

(125 citation statements)

References 28 publications

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“…From this large, multicenter matched cohort study, it became clear that LDP was not only feasible, but could also offer additional benefits as compared to the open approach. Since 2008, these findings have been corroborated by numerous single center [8][9][10][11][12] and multicenter reports [13,14], as well as those of several meta-analyses [4,15].…”

mentioning

confidence: 60%

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Kooby

Vollmer

2015

J Hepato Biliary Pancreat

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Laparoscopic approaches exist for most operations traditionally performed using open techniques, and an increasing number of organ resections are being performed laparoscopically. The potential benefits of laparoscopic over the open approach include reduced operative blood loss, fewer surgical complications, shorter hospital stays, and faster recovery times. Cholecystectomy and adrenalectomy are two such examples of organ resections more commonly performed laparoscopically than open in the United States, as the complexity of these operations is relatively low for experienced surgeons in properly selected patients. Laparoscopic colectomy had a slower evolution given the increased complexity of the procedure, but the value of the laparoscopic approach was demonstrated through several multicenter randomized trials [1,2], facilitated by the relatively large number of colectomies performed annually.Momentum for minimally invasive pancreatectomy (MIP) has been slower -likely due to the retroperitoneal location of the organ, its intimate relationship with the main mesenteric vessels, the complexity of the surgery, the inherent risk of postoperative pancreatic fistula (POPF) formation, and the relatively lower volume of cases, as compared with cholecystectomy and colectomy [3]. Of pancreatic resections, distal pancreatectomy (DP) is the most commonly achieved laparoscopically [4]. First reported in 1994, laparoscopic distal pancreatectomy (LDP) is being performed with increasing frequency worldwide despite a lack of randomized data supporting this approach over standard open distal pancreatectomy (ODP). Approximately one quarter of all DPs are performed using minimally invasive approaches [5].Drs Nakamura and colleagues from 69 medical centers in Japan used a sophisticated statistical method (propensity score matching -PSM) to address the comparison of two surgical techniques (LDP and ODP) for removing the left side of the pancreas [6]. The key findings between the two cohorts after PSM are that compared with ODP, LDP is associated with lower blood loss (254 ± 384 vs. 499 ± 740, <0.001), fewer blood transfusion (4% vs. 6.8%, P = 0.02), fewer grade B and C POPF (18.4% vs. 28.2%, P < 0.001), a higher percentage of splenic preservations (29.9% vs. 13.2%, P < 0.001), and shorter hospital stays (18.8 ± 14.7 vs. 23.2 ± 18.8, P = 0.001). In great part, these results support data from prior studies.In 2008 Results of this study demonstrated that there were no significant differences in OR time (216 vs. 230 min; P = 0.3), development of major pancreatic fistula (18% vs. 11%; P = 0.1), major complication (17% vs. 10%; P = 0.08), or 30-day mortality (1% vs. 0%; P = 0.040) between the groups (ODP vs. LDP, respectively). As compared with ODP, LDP was associated with lower estimated blood loss

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mentioning

confidence: 60%

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Kooby

Vollmer

2015

J Hepato Biliary Pancreat

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“…[15] 5.9/8.6 a 0%/4.8% NS N/A 50%/46% 3.26/7.73 a 25%/42% a 0 N/A Nakamura et al [16] 10/25. [17] 6.2/9 N/A 14.2%/0% N/A N/A 2.3/3.8 0%/0% 0 N/A Eom et al [18] 11.5/13.5 a 0 35.5%/24.2% N/A 9.7%/6.5% 3.95/6.15 a 9.7%/6.5% N/A N/A Kim et al [19] 10/16 a 0 24.7%/29% N/A 8.6%/14.3% 3/3 0 N/A N/A Matsumoto et al [20] 12.9/23.8 a 0 7.1%/21.1% N/A 0%/10.5% 3.0/3.4 0 N/A N/A Misawa et al [21] 10/16 a 0 N/A N/A 0%/22% 7.5/2 0%/0% N/A N/A Tang et al [22] 7/11 0 33.3%/0% N/A 22.2%/0% N/A 0%/0% 0%/0% N/A Teh et al [23] 6.2/10.6 a 0 16.7%/56.2% a 0 8.3%/6.2% 3.4/3.4 0%/0% N/A N/A Velanovich et al [24] 5/8 a N/A 20%/27% N/A 13%/13% N/A 20%/32% N/A N/A Fernández-Cruz et al [25] 6 pancreaticoduodenectomy. A summary of series that compare the pre-operative, intra-operative and post-operative factors and outcomes in MIPD and OPD at their institutions is shown in Tables 3 and 4 [35][36][37][38] .…”

Section: Oncologic Outcomesmentioning

confidence: 99%

“…As a result, the application of laparoscopy to pancreatectomy has been slower compared to other abdominal procedures. As surgeons become more adept at advanced laparoscopy, there is increasing evidence demonstrating not only the safety and feasibility of laparoscopic pancreatic [3] 42/76 27.3/26.5 NS 35.7%/22.4% 304/281 375/375 11.9% Mehta et al [4] 30/30 N/A N/A 70%/30% a 188/226 294/729 a N/A Limongelli et al [5] 16/29 26.4/27.1 NS 31%/14% 204/160 a 160/365 a 6.0% Soh et al [6] 10/21 25/21 NS N/A 383/330 275/600 a N/A Butturini et al [7] 43/73 N/A N/A 44.2%/11% a 180/180 N/A 0.0% Cho et al [8] 254/439 NS NS 34%/10% a NS 24%/54% (> 300cc) 9.4% Aly et al [9] 40/35 21/21 N/A 32%/8% a 342/250 a 363/606 a 10.0% DiNorcia et al [10] 71/192 N/A NS 15.5%/15.6% 250/270 a 150/900 a 25.3% Jayaraman et al [11] 107/236 27/27 N/A 21%/14% 194/163 a 150/350 a 30.0% Kooby et al [12] 23/189 28.5/26.2 NS N/A 238/230 422/790 a 17.0% Vijan et al [13] 100/100 27.4/27.9 NS 25%/N/A 214/208 171/519 a 4.0% Baker et al [14] 27/85 N/A NS N/A 236/253 219.4/612.6 a 3.6% Finan et al [15] 44/104 28.3/26.9 NS 2%/2.7% 156/200 a 157/719 a 4.1% Nakamura et al [16] 21 [17] 7/4 29.5/29 N/A 100%/100% 182/152 214/362 0.0% Eom et al [18] 31 [19] 93 [20] 14/19 N/A NS N/A 290.7/213.8 a 247.1/400.3 7.0% Misawa et al [21] 8/9 N/A N/A 12.5%/0% 255/205 14/307 a 0.0% Tang et al [22] 9/5 N/A NS 55.6%/0% 180/210 100/450 a 0.0% Teh et al [23] 12 [24] 15/15 N/A N/A 0%/0% N/A N/A 20.0% Fernández-Cruz et al [25] 5/41…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic pancreatectomy: Indications and outcomes

Liang

Hameed

Jayaraman

2014

WJG

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The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and shortterm oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons' experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. Key words: Laparoscopy; Distal pancreatectomy; Pancreaticoduodenectomy; Robotic pancreatectomy; Enucleation Core tip: This review discusses recent advances in laparoscopic distal pancreatectomy (LDP), minimally invasive pancreaticoduodenectomy (MIPD), and enucleation. Recent studies show that LDP have improved perioperative recovery and equivalent oncologic outcomes. Studies on MIPD demonstrate that it is safe in terms of intra-operative outcomes, post-operative recovery and early oncologic outcomes; however, it requires advanced laparoscopic skills. Laparoscopic enucleation has become the operation of choice for small benign tumours that are away from the main pancreatic duct, especially insulinomas. We also summarize key results in pre-operative, perioperative and post-operative outcomes from contemporary series comparing open and laparoscopic pancreatic resections in the tables.

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“…However, in their meta-analysis, Nigri et al [46] argued that devices are often equally used in LDP and ODP, but other practices or habits may influence results.A Korean single-centre study found significantly higher total costs for LDP, but LoS in this series was higher than any other published study (11.5 ± 4.1 days for LDP and 13.5 ± 4.9 days for ODP), reflecting the importance of different practices. [47] All subsequent studies found that although the operative costs were higher for minimally invasive procedures, decreased LoS after laparoscopic resection balanced, at least, overall costs. [30,48] Rutz et al [7] found a mean operative cost of $4,900 for ODP and $5,756 for LDP, but calculated a mean total cost of care of $13,900 for the open procedure vs. $10,480 for the laparoscopic one.…”

Section: Discussionmentioning

confidence: 99%

Mini-invasive distal pancreatectomy: a feasible and cost-effective technique

Basso¹,

Maffeis²,

Lumachi³

et al. 2017

MIS

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Aim: Laparoscopic pancreatic surgery is a minimally invasive technique that has been widely applied only in the past decade. The purpose of this study was to evaluate its safety and assess whether laparoscopic distal pancreatectomy (LDP) is cost-effective compared with open distal pancreatectomy (ODP). Methods: The medical records of patients treated for leftsided pancreatic lesions were retrospectively analysed, and the analysis of costs for hospital stay, operative time, and equipment were analysed. Twelve patients underwent LDP, while 12 patients underwent ODP. Results: The two groups were homogeneous according to age, ASA score, BMI, and distribution of pathological findings. Both the size of the specimen (5.33 ± 3.2 vs. 5.58 ± 2.57 cm) and the number of removed lymph nodes (10.5 ± 4.3 vs. 12.1 ± 3.1) did not differ. Although LDP required a longer operative time (197.5 ± 33.7 vs. 122.5 ± 35.4 min), intraoperative bleeding, postoperative pain intensity (measured by VAS scale) and hospital stay were significantly reduced. Conclusion: The mini-invasive approach offers several advantages compared with open surgery, including a significant reduction of blood loss and postoperative pain, and an earlier recovery. The global costs of laparoscopic surgery should be carefully re-evaluated, considering the saving that arises from these advantages. Key words:Mini-invasive, distal pancreatectomy, laparoscopy, cost ABSTRACTArticle history:

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Clinical outcomes compared between laparoscopic and open distal pancreatectomy

Abstract: Laparoscopic distal pancreatectomy is a clinically safe and effective procedure for benign and borderline pancreatic tumors.

Cited by 129 publications

References 28 publications

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Laparoscopic pancreatectomy: Indications and outcomes

Mini-invasive distal pancreatectomy: a feasible and cost-effective technique

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