title: Laparoscopic Versus Open Distal Pancreatectomy for Pancreatic Adenocarcinoma.
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) has been shown to have short-term benefits over open distal pancreatectomy (ODP). Its application for pancreatic ductal adenocarcinoma (PDAC) remains controversial.
  
  
  METHODS
  From 1995 to 2014, 72 patients underwent distal pancreatectomy for PDAC at a single institution and were included in the study. Postoperative and long-term outcomes of patients undergoing LDP (n = 44) or ODP (n = 28) were compared.
  
  
  RESULTS
  LDP was associated with less blood loss (332 vs. 874 mL, p = 0.0012) and lower transfusion rates than ODP (18.2 vs. 50 %, p = 0.0495). Operative time was similar (254 vs. 266 min) for LDP and ODP; five patients (11.4 %) required conversion to ODP. Pancreatic fistulas (13.6 vs. 7.1 %) and major complications (13.6 vs. 25 %), were similar between LDP and ODP, respectively. Length of hospital stay (5.1 vs. 9.4 days, p = 0.0001) and time to initiate adjuvant therapy (69.4 vs. 95.6 days, p = 0.0441) was shorter for LDP than ODP. Tumor characteristics were similar but LDP was associated with more resected lymph nodes than ODP (25.9 vs. 12.7, p = 0.0001). One-, three-, and five-year survival rates were similar between LDP (69, 41, and 41 %, respectively) and ODP (78, 44, and 32 %, respectively).
  
  
  CONCLUSIONS
  LDP is associated with less blood loss and need for blood transfusion, shorter hospital stay, and faster time to initiate adjuvant therapy than ODP for patients with PDAC. Postoperative outcomes and long-term survival are similar between the two groups. LDP appears to be safe in the treatment of patients with PDAC.
authors: Division of General Surgery, Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
authors: John A
authors: JA
authors: Stauffer
authors: Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Alessandro
authors: A
authors: Coppola
authors: Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
authors: Kabir
authors: K
authors: Mody
authors: Division of General Surgery, Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA. asbun.horacio@mayo.edu.
authors: Horacio J
authors: HJ
authors: Asbun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors