Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score‐matching

Abstract

Background Laparoscopic distal pancreatectomy has been shown to be associated with favorable postoperative outcomes using meta-analysis. However, there have been no randomized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching. Methods We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006-2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis. Results After propensity score-matching, laparoscopic distal pancreatectomy was associated with favorable perioperative outcomes compared with open distal pancreatectomy, including higher rate of preservation of spleen and splenic vessels (P < 0.001); lower rates of intraoperative transfusion (P = 0.020), clinical grade of pancreatic fistula (International Study Group on Pancreatic Fistula grade B and C; P < 0.001), and morbidity (P < 0.001); and shorter hospital stay (P = 0.001), but a longer operative time (P < 0.001). Conclusions Laparoscopic distal pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy.

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

“…However, most pancreatic surgeons encounter complications after DP, especially postoperative pancreatic fistula (POPF). The incidence of POPF after DP has been reported to range from 18.6 to 64.9 % [2][3][4]. POPF causes a variety of postoperative complications, such as intra-abdominal abscess, delayed gastric emptying, and postoperative hemorrhage, due to pseudoaneurysm rupture.…”

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

“…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).…”

Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy – A single-center series

“…Similarly, a review on laparoscopic surgery published in 2016 concluded that laparoscopic DP can be safely performed in high-volume centers, but that randomized controlled trials still have to confirm the effectiveness of the procedure [23]. A large propensity score-matching comparative study from Japan even showed that morbidity was diminished with laparoscopic DP along with intraoperative transfusion, and LoS [24]. Only the operative time was longer.…”