Laparoscopic vs open distal pancreatectomy: a single-institution comparative study.
OBJECTIVE
Laparoscopic distal pancreatectomy (LDP) provides outcome advantages compared with open distal pancreatectomy (ODP).


METHODS
Single-institutional, retrospective review from January 1, 2004, to May 1, 2009.


METHODS
Tertiary referral center.


METHODS
Patients undergoing LDP (n = 100) were matched by age, pathologic diagnosis, and pancreatic specimen length to a cohort undergoing ODP (n = 100).


METHODS
Perioperative outcomes and overall 30-day morbidity and mortality. Univariate and multivariate analyses were performed using logistic or linear regression as appropriate.


RESULTS
Patients in the LDP group did not differ from those in the ODP group in age (mean, 59.0 vs 58.6 years; P = .85), sex (60% vs 50% female; P = .16), body mass index (calculated as weight in kilograms divided by height in meters squared) (mean, 27.4 vs 27.9; P = .44), or American Society of Anesthesiologists score of 3 or higher (58% vs 52%; P = .39). Tumor size was greater in the ODP group than in the LDP group (mean, 4.0 vs 3.3 cm; P = .02). The LDP group as compared with the ODP group demonstrated decreased blood loss (mean, 171 vs 519 mL; P < .001) and shorter duration of hospital stay (mean, 6.1 vs 8.6 days; P < .001). There were no differences between the LDP and ODP groups in operative time (mean, 214 vs 208 minutes; P = .50), pancreatic leak rate (17% vs 17%; P > .99), overall 30-day morbidity (34% vs 29%; P = .45), and 30-day mortality (3% vs 1%; P = .62).


CONCLUSIONS
The laparoscopic approach to distal pancreatectomy appears to provide advantages of reduced blood loss and length of hospital stay in selected patients compared with the open approach. Overall complication rates appear similar. Patient selection bias and limits of a retrospective analysis warrant prospective validation.
Vijan
Sandeep S
SS
Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Ahmed
Kamran A
KA
Harmsen
William S
WS
Que
Florencia G
FG
Reid-Lombardo
Kaye M
KM
Nagorney
David M
DM
Donohue
John H
JH
Farnell
Michael B
MB
Kendrick
Michael L
ML
D018784:Abdominal Abscess / Q000209:etiology; D000368:Aged; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000209:etiology; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D010535:Laparoscopy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D015983:Selection Bias; D054556:Venous Thromboembolism / Q000209:etiology