title: Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients.
abstract: Laparoscopy is widely accepted as a feasible option for distal pancreatectomy. However, the experience in laparoscopic distal pancreatectomy (LDP) for pancreatic ductal adenocarcinoma (PDAC) is limited to a small number of studies, reported by expert centers. The present study aimed to evaluate perioperative and oncological outcomes after LDP for PDAC in a large, multicenter cohort of patients.
  
  
  
  A retrospective analysis of the data on 196 patients with histologically verified PDAC, operated at Oslo University Hospital-Rikshospitalet (Oslo, Norway), Asan Medical Center (Seoul, Republic of Korea), Institut Mutualiste Montsouris (Paris, France) and University Hospital Southampton (Southampton, UK) between January 2002 and April 2015 was conducted. The patients with standard (SLDP) and extended (i.e., en bloc with adjacent organ, ELDP) resections were compared in terms of perioperative and oncological outcomes.
  
  
  
  Out of 196 LDP procedures, 191 (97.4 %) were completed through laparoscopy, while five (2.6 %) were converted to open surgery. ELDP was performed in 30 (15.7 %) cases. Sixty-one (31.9 %) patients experienced postoperative complications, including 48 (25.1 %) with pancreatic fistula. The rate of clinically relevant fistula (grade B/C) was 15.7 %. Median postoperative hospital stay was 8 (2-63) days. Median follow-up was 16 months. Median survival was 31.3 months (95 % CI 22.9-39.6). Three- and 5-year actuarial survival rates were 42.4 and 30 %, respectively. SLDP was associated with significantly higher survival compared with ELDP (p = 0.032).
  
  
  
  LDP seems to be a feasible and safe procedure, providing satisfactory oncological outcomes in patients with PDAC.
authors.affiliation: The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com.|Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com.
authors.forename: Mushegh A
authors.initials: MA
authors.lastname: Sahakyan
authors.affiliation: The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.|Department of Surgery, Finnmark Hospital, Kirkenes, Norway.
authors.forename: Airazat M
authors.initials: AM
authors.lastname: Kazaryan
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Majd
authors.initials: M
authors.lastname: Rawashdeh
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.|Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
authors.forename: Mark
authors.initials: M
authors.lastname: Shmavonyan
authors.affiliation: Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.|Department of Surgery, Vestre Viken Hospital Trust, Drammen, Norway.
authors.forename: Sven-Petter
authors.initials: SP
authors.lastname: Haugvik
authors.affiliation: Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Knut Jørgen
authors.initials: KJ
authors.lastname: Labori
authors.affiliation: Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Buanes
authors.affiliation: Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Bård Ingvald
authors.initials: BI
authors.lastname: Røsok
authors.affiliation: Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway.
authors.forename: Dejan
authors.initials: D
authors.lastname: Ignjatovic
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu Hilal
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.|Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
authors.affiliation: Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
authors.forename: Song Cheol
authors.initials: SC
authors.lastname: Kim
authors.affiliation: The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Edwin
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Ductal adenocarcinoma; Laparoscopy; Outcomes; Pancreatectomy; Survival