title: Laparoscopic distal pancreatectomy: analysis of trends in surgical techniques, patient selection, and outcomes.
abstract: BACKGROUND
  This study analyzed the time trends of demographic, operative, and pathologic variables in a consecutive series of patients undergoing laparoscopic distal pancreatectomy (LDP). In addition, we assessed the parameters potentially related to the learning curve, and evaluated the long-term outcomes.
  
  
  METHODS
  LDP performed between 1999 and 2012 (minimum follow-up of 1 year) were included in the study. The time trends were studied categorizing the operative sequence in three equal groups, and the parameters related to the learning curve were assessed using local regression techniques. All the analyses were stratified by operation type (associated splenectomy vs. spleen-preserving procedures).
  
  
  RESULTS
  The study population consisted of 100 patients. There were 57 LDP with associated splenectomy and 41 spleen-preserving LDP; conversion was necessary in 2 cases. The time trend analysis showed that there was not a tendency toward broadening the indications or selecting more difficult cases. Similarly, the study of learning curve components did not show any significant variation over time. Only 45 splenectomized patients received prophylactic vaccinations, and one unvaccinated patient developed an overwhelming post-splenectomy infection. At a median follow-up of 72.5 months, 12 patients developed diabetes mellitus, while 8 patients undergoing spleen-preserving LDP developed gastric and perigastric varices.
  
  
  CONCLUSIONS
  This analysis did not identify parameters related to the patient selection process and the learning curve in LDP. The incidence of new-onset diabetes was lower than reported in other series. The possibility of serious infections following splenectomy has to be taken into account, such that a strict adherence to vaccine protocols is strongly recommended.
authors.affiliation: Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona Hospital Trust, P.Le L.A. Scuro 10, 37134, Verona, Italy, giuseppe.malleo@ospedaleuniverona.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.forename: Isacco
authors.initials: I
authors.lastname: Damoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Esposito
authors.forename: Tiziana
authors.initials: T
authors.lastname: Marchese
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D018579:Patient Selection; D016896:Treatment Outcome