title: Comparison of open with laparoscopic distal pancreatectomy: a single institution's transition over a 7-year period.
abstract: OBJECTIVE
  Many studies have shown laparoscopic distal pancreatectomy (LDP) to have benefits over open distal pancreatectomy (ODP). This institution made a unique abrupt transition from an exclusively open approach to a preference for the laparoscopic technique. This study aimed to compare outcomes in patients undergoing LDP and ODP, respectively, over the period of transition.
  
  
  METHODS
  A retrospective review of all patients undergoing LDP (n = 82) or ODP (n = 90) was performed. Surrogate oncologic markers for the subgroup of patients with malignant disease were also studied.
  
  
  RESULTS
  The ODP and LDP groups were well matched with regard to demographics, comorbidities and tumour characteristics. Significant differences were noted in favour of the LDP group in which decreases were seen in estimated blood loss (<0.001), need for packed red blood cell transfusions (<0.001), length of hospital stay (<0.001) and intensive care unit stay (<0.001). No other significant differences in the occurrence of complications or oncologic outcomes were seen. Rates of Grade B and C fistulae were 10% and 6% in the ODP and LDP groups, respectively. Grade III-V complications occurred in 20% and 13% of the ODP and LDP groups, respectively.
  
  
  CONCLUSIONS
  Laparoscopic distal pancreatectomy continues to compare favourably with ODP when well-matched patient series are reviewed. The results show a decreased need for blood transfusions and hospital resources in LDP. Additionally, there may be oncologic advantages associated with LDP compared with ODP in pancreatic malignancies.
authors.affiliation: Department of General Surgery, Mayo Clinic, Jacksonville, FL 32224, USA. stauffer.john@mayo.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Stauffer
authors.forename: Armando
authors.initials: A
authors.lastname: Rosales-Velderrain
authors.forename: Ross F
authors.initials: RF
authors.lastname: Goldberg
authors.forename: Steven P
authors.initials: SP
authors.lastname: Bowers
authors.forename: Horacio J
authors.initials: HJ
authors.lastname: Asbun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016063:Blood Loss, Surgical; D005260:Female; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology