title: Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study.
abstract: OBJECTIVE
  To compare the peri-operative outcomes for laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign or premalignant pancreatic neoplasms in two institutions.
  
  
  METHODS
  This prospective comparative study included 91 consecutive patients who underwent LDP (n=45) or ODP (n=46) from Jan. 2010 to Dec. 2012. Demographics, intra-operative characteristics, and post-operative outcomes were compared.
  
  
  RESULTS
  The median operating time in the LDP group was (158.7±38.3) min compared with (92.2±24.1) min in the ODP group (P<0.001). Patients had lower blood loss in LDP than in the ODP ((122.6±61.1) ml vs. (203.1±84.8) ml, P<0.001). The rates of splenic conservation between the LDP and ODP groups were similar (53.3% vs. 47.8%, P=0.35). All spleen-preserving distal pancreatectomies were conducted with vessel preservation. LDP also demonstrated better post-operative outcomes. The time to oral intake and normal daily activities was faster in the LDP group than in the ODP group ((1.6±0.5) d vs. (3.2±0.7) d, P<0.01; (1.8±0.4) d vs. (2.1±0.6) d, P=0.02, respectively), and the post-operative length of hospital stay in LDP was shorter than that in ODP ((7.9±3.8) d vs. (11.9±5.8) d, P=0.006). No difference in tumor size ((4.7±3.2) cm vs. (4.5±1.8) cm, P=0.77) or overall pancreatic fistula rate (15.6% vs. 19.6%, P=0.62) was found between the groups, while the overall post-operative complication rate was lower in the LDP group (26.7% vs. 47.8%, P=0.04).
  
  
  CONCLUSIONS
  LDP is safe and effective for benign or premalignant pancreatic neoplasms, featuring lower blood loss and substantially faster recovery.
authors.affiliation: Department of General Surgery, Institute of Micro-Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; Department of General Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Jia-fei
authors.initials: JF
authors.lastname: Yan
authors.forename: Tian-tao
authors.initials: TT
authors.lastname: Kuang
authors.forename: Da-yong
authors.initials: DY
authors.lastname: Ji
authors.forename: Xiao-wu
authors.initials: XW
authors.lastname: Xu
authors.forename: Dan-song
authors.initials: DS
authors.lastname: Wang
authors.forename: Ren-chao
authors.initials: RC
authors.lastname: Zhang
authors.forename: Wei-wei
authors.initials: WW
authors.lastname: Jin
authors.forename: Yi-ping
authors.initials: YP
authors.lastname: Mou
authors.forename: Wen-hui
authors.initials: WH
authors.lastname: Lou
mesh_terms: D000203:Activities of Daily Living; D002681:China; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000601:surgery; D016896:Treatment Outcome
keywords: Distal pancreatic resection; Laparoscopy; Pancreatic benign tumors; Pancreatic neoplasm; Splenic preservation