Laparoscopic Distal Pancreatectomy for Pancreatic Tumors: Does Size Matter?

Fernández‐Cruz, Laureano; Poves, Ignasi; Pelegrina, Amalia; Burdı́o, Fernando; Sánchez‐Cabús, Santiago; Grande, Luís

doi:10.1159/000445008

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…Distal pancreatectomy is commonly applied for the resection of pancreatic diseases located in the body and/or tail of the pancreas, such as pancreatic ductal adenocarcinoma, cystic neoplasm, neuroendocrine neoplasm, and chronic pancreatitis 1–3 . Although surgical techniques and perioperative managements for DP were significantly improved in past decades, the complications following DP were still great challenges for surgeons specialized in pancreatic surgery, especially postoperative pancreatic fistula 4 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis

Peng

Zhu

Yin

et al. 2017

Sci Rep

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Postoperative pancreatic fistula (POPF) is a common complication following distal pancreatectomy (DP). However, the risk factors of this complication in patients after DP still remain controversial. The aim of our study is to estimate the association between potential risk factors and POPF. Relevant articles published up to June 21, 2016 were identified via PubMed, EMBASE, Web of Science, and The Cochrane Library. Studies that examined the risk factors of POPF following DP were enrolled. 20 articles (2070 patients) were finally included in this study. The pooled data suggested that patients with soft pancreas, higher Body Mass Index (BMI), blood transfusion, elevated intraoperative blood loss, and longer operative time had a decreased risk for POPF. However, age, gender, malignant pathology, types of stump closure, octreotide therapy, history of diabetes and chronic pancreatitis, splenectomy, multiorgan resection, main duct ligation, preoperative serum albumin levels, PGA felt wrapping, and extended lymphadenectomy could not be regarded as risk factors for POPF. Our analytic data demonstrated that pancreas texture, BMI, blood transfusion, intraoperative blood loss, and operative time were clinical predictor for POPF. This study may assist surgeons to screen patients with high risk of POPF and select appropriate treatment measures.

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Section: Introductionmentioning

confidence: 99%

Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis

Peng

Zhu

Yin

et al. 2017

Sci Rep

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“…Another recent series of distal pancreatectomies showed similar results in terms of R0/R1/R2 rates, and a median of 16 harvested lymph nodes in LDP vs. 14 in ODP. [13] Fernandez-Cruz et al [23] performed 27 LDP, achieving an R0 resection in 90% of ductal adenocarcinomas, and removing a median of 6 lymph nodes in the LDP group vs. 8 in the ODP group. Interestingly, in our series, the number of removed lymph nodes was similar and adequate in both groups, despite benign and malignant diseases having been included (10.55 ± 4.3 vs. 12.08 ± 3.12, P = NS).…”

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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“…The association between age, obesity, functional status, tumor size, stage and the outcomes of LDP has been addressed in the literature, also by our research group. [3][4][5][6][7][8] Another important aspect in the planning and execution of LDP is patient's previous surgical history, particularly, the presence of prior upper abdominal surgery (PUAS).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Distal Pancreatectomy Following Prior Upper Abdominal Surgery (Pancreatectomy and Prior Surgery)

Sahakyan

Tholfsen

Kleive

et al. 2021

Journal of Gastrointestinal Surgery

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Background and Purpose Previous abdominal surgery can be a risk factor for perioperative complications in patients undergoing laparoscopic procedures. Today, distal pancreatectomy is increasingly performed laparoscopically. This study investigates the consequences of prior upper abdominal surgery (PUAS) for laparoscopic distal pancreatectomy (LDP). Methods Patients who had undergone LDP from April 1997 to January 2020 were included. Based on the history and type of PUAS, these were categorized into three groups: minimally invasive (I), open (II), and no PUAS (III). To reduce possible confounding factors, the groups were matched in 1:2:4 fashion based on age, sex, body mass index (BMI) and American Society of Anesthesiology grade. Results After matching, 30, 60, and 120 patients were included in the minimally invasive, open and no PUAS groups, respectively. No statistically significant differences were found in terms of intraoperative outcomes. Postoperative morbidity, mortality and length of hospital stay were similar. Open PUAS was associated with higher Comprehensive Complication Index (33.7 vs 20.9 vs 26.2, p = 0.03) and greater proportion of patients with ≥ 2 complications (16.7 vs 0 vs 6.7%, p = 0.02) compared with minimally invasive and no PUAS. Male sex, overweight (BMI 25–29.9 kg/m2), diagnosis of neuroendocrine neoplasia, and open PUAS were risk factors for severe morbidity in the univariable analysis. Only open PUAS was statistically significant in the multivariable model. Conclusions PUAS does not impair the feasibility and safety of LDP as its perioperative outcomes are largely comparable to those in patients without PUAS. However, open PUAS increases the burden and severity of postoperative complications.

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Laparoscopic Distal Pancreatectomy for Pancreatic Tumors: Does Size Matter?

Cited by 11 publications

References 26 publications

Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis

Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis

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

Laparoscopic Distal Pancreatectomy Following Prior Upper Abdominal Surgery (Pancreatectomy and Prior Surgery)

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