title: A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease.
abstract: BACKGROUND
  Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking.
  
  
  METHODS
  Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade ≥III).
  
  
  RESULTS
  Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training.
  
  
  CONCLUSIONS
  Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: de Rooij
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Anneke P
authors.initials: AP
authors.lastname: Jilesen
authors.affiliation: Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Djamila
authors.initials: D
authors.lastname: Boerma
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Bert A
authors.initials: BA
authors.lastname: Bonsing
authors.affiliation: Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
authors.forename: Koop
authors.initials: K
authors.lastname: Bosscha
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: van Dam
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: van Dieren
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marcel G
authors.initials: MG
authors.lastname: Dijkgraaf
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gerhards
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.affiliation: Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Ignace H
authors.initials: IH
authors.lastname: de Hingh
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
authors.affiliation: Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
authors.forename: Joost M
authors.initials: JM
authors.lastname: Klaase
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Els J
authors.initials: EJ
authors.lastname: Nieveen van Dijkum
authors.affiliation: Department of Surgery, Isala Clincs, Zwolle, the Netherlands.
authors.forename: Gijs A
authors.initials: GA
authors.lastname: Patijn
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Scheepers
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, the Netherlands.
authors.forename: George P
authors.initials: GP
authors.lastname: van der Schelling
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Egbert
authors.initials: E
authors.lastname: Sieders
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Jantien A
authors.initials: JA
authors.lastname: Vogel
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Olivier R
authors.initials: OR
authors.lastname: Busch
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: m.g.besselink@amc.nl.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D057194:Intention to Treat Analysis; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057216:Propensity Score; D066231:Surgeons; D016896:Treatment Outcome