Surgical adjuncts to laparoscopic distal pancreatectomy

Robinson, Stuart; Saif, Rehan; Charnley, Richard; French, Jeremy; White, Steve

doi:10.3109/13645706.2010.540016

Cited by 9 publications

(11 citation statements)

References 17 publications

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“…Similar surgical techniques were used in all centers with minor variation in regard to patient's and surgeon's position. The detailed procedure has been previously described by some of our authors [23][24][25][26]. A similar technique was adopted in all centers.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

et al. 2019

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Background The laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery. Although favorable postoperative short-term outcomes have been reported in open spleen-preserving distal pancreatectomy when compared to distal pancreatectomy with splenectomy, it is unclear whether this observation applies to the laparoscopic approach. The aim of this study is to compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LDPS). Study design This is a UK wide, propensity score-matched study, including patients who underwent LSPDP or LDPS between 2006 and 2016. Short-term outcomes were compared between LSPDP and LDPS according to intention to treat. Additionally, risk factors for unplanned splenectomy were explored. Results A total of 456 patients were included from eleven centers (229 LSPDP and 227 LDPS). We were able to match 173 LSPDP cases to 173 LDPS cases, according to intention to treat. No differences were seen in postoperative morbidity between the groups. The only identified risk factor for unplanned splenectomy was tumor size ≥ 30 mm. Conclusions Preserving the spleen during laparoscopic distal pancreatectomy is not associated with a lower postoperative morbidity compared to sacrificing the spleen. Tumor size is a risk factor for unplanned splenectomy.Keywords Laparoscopic distal pancreatectomy · Laparoscopic spleen-preserving distal pancreatectomy · Splenectomy · Benign · Low-grade malignant and Other Interventional TechniquesThe members of the Minimally Invasive liver and Pancreatic Surgery Study Group-UK (MI-LAPS UK) have been included in Acknowledgement section.

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Section: Surgical Proceduresmentioning

confidence: 99%

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

et al. 2019

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“…The absence of an anastomosis in distal pancreatectomy makes the procedure inherently more suited to the laparoscopic approach than pancreaticoduodenectomy. Details of technique of LDP are well described elsewhere 2, 3, but two variations merit particular discussion when considering LDP for malignancy: the splenic‐preserving approach and consideration of a hand‐access approach.…”

Section: Laparoscopic Distal Pancreatectomymentioning

confidence: 99%

Laparoscopic pancreatectomy for malignancy

Fisher

Kooby

2012

Journal of Surgical Oncology

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Utilization of laparoscopic techniques for resection of the pancreas has slowly gained acceptance in specific situations and is now being applied to more challenging endeavors, such as pancreaticoduodenectomy for cancer. This review provides a summary of laparoscopic applications for pancreatic malignancy, with specific attention to the most common methods of pancreatic resection and their respective oncologic outcomes, including margin status, lymph node retrieval, and survival.

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“…In 2007, the National Institute for Health and Care Excellence (NICE) published recommendations for careful implementation of laparoscopic distal pancreatectomy (LDP) for the management of cystic lesions and neuroendocrine tumours (NETs) in the UK. Since then a number of UK centres have started reporting their experience, highlighting potential advantages of the laparoscopic approach in terms of blood loss and duration of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy

Lof

Moekotte

Al-Sarireh

et al. 2019

British Journal of Surgery

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Background: Laparoscopic distal pancreatectomy (LDP) is increasingly being performed as an alternative to open surgery. Whether the implementation and corresponding learning curve of LDP have an impact on patient outcome is unknown. The aim was to investigate the temporal trends in practice across UK centres. Methods: This was a retrospective multicentre observational cohort study of LDP in 11 tertiary referral centres in the UK between 2006 and 2016. The learning curve was analysed by pooling data for the first 15 consecutive patients who had LDP and examining trends in surgical outcomes in subsequent patients. Results: In total, 570 patients underwent LDP, whereas 888 underwent open resection. For LDP the median duration of operation was 240 min, with 200 ml blood loss. The conversion rate was 12⋅1 per cent. Neuroendocrine tumours (26⋅7 per cent) and mucinous cystic neoplasms (19⋅7 per cent) were commonest indications. The proportion of LDPs increased from 24⋅4 per cent in 2006-2009 (P1) to 46⋅0 per cent in 2014-2016 (P3) (P < 0⋅001). LDP was increasingly performed for patients aged 70 years or more (16 per cent in P1 versus 34⋅4 per cent in P3; P = 0⋅002), pancreatic ductal adenocarcinoma (6 versus 19⋅1 per cent; P = 0⋅005) and advanced malignant tumours (27 versus 52 per cent; P = 0⋅016). With increasing experience, there was a trend for a decrease in blood transfusion rate (14⋅1 per cent for procedures 1-15 to 3⋅5 per cent for procedures 46-75; P = 0⋅008), ICU admissions (32⋅7 to 19⋅2 per cent; P = 0⋅021) and median duration of hospital stay (7 (i.q.r. 5-9) to 6 (4-7) days; P = 0⋅002). After 30 procedures, a decrease was noted in rates of both overall morbidity (57⋅7 versus 42⋅2 per cent for procedures 16-30 versus 46-75 respectively; P = 0⋅009) and severe morbidity (18⋅8 versus 9⋅7 per cent; P = 0⋅031).Conclusion: LDP has increased as a treatment option for lesions of the distal pancreas as indications for the procedure have expanded. Perioperative outcomes improved with the number of procedures performed. * Other members of the Minimally Invasive Liver and Pancreatic Surgery Study Group -UK are co-authors of this study and can be found under the heading Collaborators

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Surgical adjuncts to laparoscopic distal pancreatectomy

Cited by 9 publications

References 17 publications

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

Laparoscopic pancreatectomy for malignancy

Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy

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