title: Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach.
abstract: BACKGROUND
  Laparoscopic left pancreatic resections are being increasingly performed. In this study, we provide a nonrandomized comparison between laparoscopic and open left pancreatectomy (OLP) for benign and borderline tumors, focusing on both perioperative and long-term results.
  
  
  METHODS
  Demographic, pathologic, and perioperative details from patients who underwent laparoscopic and OLP between 1999 and 2006 were retrieved from our database and analyzed. Long-term results, including resume to full-time work, occurrence of incisional hernias, and incidence of exocrine and endocrine insufficiency also were evaluated.
  
  
  RESULTS
  A total of 116 patients were included in the analysis; 43 (37.1%) were managed laparoscopically and 73 (62.9%) underwent the open procedure. There were no significant differences regarding clinical and pathological data. All of the resections attempted laparoscopically were completed. The rate of splenic preservation was significantly higher in the laparoscopic group (P = 0.0001). Postoperative outcomes were similar between the two groups. Longitudinal comparison between two time periods (1999-June 2004 vs. July 2004-2006) showed that pancreatic fistula and hospital stay significantly diminished over time in the laparoscopic group (P = 0.04 and P = 0.004, respectively). Median follow-up was 53 months. The incidence of exocrine insufficiency and incisional hernias was significantly higher after open resections (both P = 0.05). After hospital discharge, median time to resume full-time work was 6 weeks in the open group and 3 weeks after laparoscopic resections (P < 0.0001). Laparoscopy also resulted as an independent factor for an early resume to full-time activities in the multivariate analysis (P < 0.0001).
  
  
  CONCLUSIONS
  Laparoscopic left pancreatectomy is a safe procedure for benign and borderline tumors, with similar perioperative outcomes compared with the open procedure. In the long term, the laparoscopic approach is likely to be superior thanks to a more rapid resume of full-time activities and to the lower incidence of incisional hernias and exocrine insufficiency. Clearly, these results have yet to be confirmed in large, randomized trials.
authors.affiliation: Department of Surgery, G.B. Rossi Hospital, University of Verona, P.Le L.A. Scuro 10, 37134 Verona, Italy. giovanni.butturini@ospedaleuniverona.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossini
authors.forename: Luca
authors.initials: L
authors.lastname: Casetti
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Melotti
authors.forename: Micaela
authors.initials: M
authors.lastname: Piccoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000041:Absenteeism; D000208:Acute Disease; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D010185:Pancreatic Fistula / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000601:surgery; D010195:Pancreatitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome