title: A Case-matched Comparative Study of Laparoscopic Versus Open Distal Pancreatectomy.
abstract: BACKGROUND
  Although the laparoscopic approach to distal pancreatectomy for benign and malignant diseases is largely replacing open surgery in some centers, well-designed studies comparing these approaches are limited. We present a case-matched study that compares the outcomes of laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP).
  
  
  METHODS
  Of 112 patients (51 female) who underwent surgery between January 2002 and December 2011, 44 patients were matched on a 1:1 basis (22 LDP, 22 ODP) according to age, sex, and tumor size. Outcomes were compared on an intention-to-treat basis. Data shown represent median where appropriate.
  
  
  RESULTS
  The laparoscopic and open groups were comparable for age (57 vs. 59.9 y, P=0.980), sex distribution (P=1.000), tumor size (3 vs. 4 cm, P=0.904), and the frequency of benign versus malignant disease (P=0.920). LDP was associated with significantly lower blood loss (100 vs. 500 mL, P=0.001), higher spleen preservation rate (45% vs. 18%, P=0.029), as well as shorter high dependency unit stay (1 vs. 5 d, P=0.001) and postoperative hospital stay (5 vs. 14 d, P=0.017). There was no significant difference in operating time (245 vs. 240 min, P=0.602) and postoperative morbidity (13.6% vs. 27.2%, P=0.431). In patients with malignant disease, there were no differences in R0 resection margin status (90% vs. 85.7%, P=0.88), the numbers of lymph nodes retrieved (12.7 vs. 14.1, P=0.82), the 1- and 2-year survival rates (89% vs. 81%, P=0.54 and 74.2% vs. 71.5%, P=0.63, respectively), and the mean duration of survival (45 vs. 31 mo, P=0.157).
  
  
  CONCLUSIONS
  The laparoscopic approach to distal pancreatectomy offers advantages over open surgery in terms of reductions in operative trauma and duration of postoperative recovery without compromising the oncologic resection.
authors.affiliation: *The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital †Institute of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
authors.forename: Yazan S
authors.initials: YS
authors.lastname: Khaled
authors.forename: Deep J
authors.initials: DJ
authors.lastname: Malde
authors.forename: Jessica
authors.initials: J
authors.lastname: Packer
authors.forename: Nicola
authors.initials: N
authors.lastname: De Liguori Carino
authors.forename: Rahul
authors.initials: R
authors.lastname: Deshpande
authors.forename: Derek A
authors.initials: DA
authors.lastname: O'Reilly
authors.forename: David J
authors.initials: DJ
authors.lastname: Sherlock
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome