Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches.
OBJECTIVE
To compare perioperative outcomes of laparoscopic left-sided pancreatectomy (LLP) with traditional open left-sided pancreatectomy (OLP) in a multicenter experience.


BACKGROUND
LLP is being performed more commonly with limited data comparing results with outcomes from OLP.


METHODS
Data from 8 centers were combined for all cases performed between 2002-2006. OLP and LLP cohorts were matched by age, American Society of Anesthesiologists, resected pancreas length, tumor size, and diagnosis. Multivariate analysis was performed using binary logistic regression.


RESULTS
Six hundred sixty-seven LPs were performed, with 159 (24%) attempted laparoscopically. Indications were solid lesion in 307 (46%), cystic in 295 (44%), and pancreatitis in 65 (10%) cases. Positive margins occurred in 51 (8%) cases, 335 (50%) had complications, and significant leaks occurred in 108 (16%). Conversion to OLP occurred in 20 (13%) of the LLPs. In the matched comparison, 200 OLPs were compared with 142 LLPs. There were no differences in positive margin rates (8% vs. 7%, P = 0.8), operative times (216 vs. 230 minutes, P = 0.3), or leak rates (18% vs. 11%, P = 0.1). LLP patients had lower average blood loss (357 vs. 588 mL, P < 0.01), fewer complications (40% vs. 57%, P < 0.01), and shorter hospital stays (5.9 vs. 9.0 days, P < 0.01). By MVA, LLP was an independent factor for shorter hospital stay (P < 0.01, odds ratio 0.33, 95% confidence interval 0.19-0.56).


CONCLUSIONS
In selected patients, LLP is associated with less morbidity and shorter LOS than OLP. Pancreatic fistula rates are similar for OLP and LLP. LLP is appropriate for selected patients with left-sided pancreatic pathology.
Kooby
David A
DA
Winship Cancer Institute, Emory University School of Medicine, 1365C Clifton Rd, NE, 2nd floor, Atlanta, GA 30322, USA. dkooby@emory.edu
Gillespie
Theresa
T
Bentrem
David
D
Nakeeb
Attila
A
Schmidt
Max C
MC
Merchant
Nipun B
NB
Parikh
Alex A
AA
Martin
Robert C G
RC
Scoggins
Charles R
CR
Ahmad
Syed
S
Kim
Hong Jin
HJ
Park
Jaemin
J
Johnston
Fabian
F
Strouch
Matthew J
MJ
Menze
Alex
A
Rymer
Jennifer
J
McClaine
Rebecca
R
Strasberg
Steven M
SM
Talamonti
Mark S
MS
Staley
Charles A
CA
McMasters
Kelly M
KM
Lowy
Andrew M
AM
Byrd-Sellers
Johnita
J
Wood
William C
WC
Hawkins
William G
WG
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology; D012189:Retrospective Studies