Laparoscopic versus open distal pancreatectomy-a propensity score-matched analysis from the German StuDoQ|Pancreas registry.
OBJECTIVE
The aim of this study was to assess intraoperative, postoperative, and oncologic outcome in patients undergoing laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for benign and malignant lesions of the pancreas.


METHODS
Data from patients undergoing distal pancreatic resection were extracted from the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. After propensity score case matching, groups of LDP and ODP were compared regarding demography, comorbidities, operative details, histopathology, and perioperative outcome.


RESULTS
At the time of data extraction, the StuDoQ|Pancreas registry included over 3000 pancreatic resections from over 50 surgical departments in Germany. Data from 353 patients undergoing ODP (n = 254) or LDP (n = 99) from September 2013 to February 2016 at 29 institutions were included in the analysis. Baseline data showed a strong selection bias in LDP patients, which disappeared after 1:1 propensity score matching. A comparison of the matched groups disclosed a significantly longer operation time, higher rate of spleen preservation, more grade A pancreatic fistula, shorter hospital stay, and increased readmissions for LDP. In the small group of patients operated for pancreatic cancer, a lower lymph node yield with a lower lymph node ratio was apparent in LDP.


CONCLUSIONS
LDP needed more time but potential advantages include increased spleen preservation and shorter hospital stay, as well as a trend for less transfusion, ventilation, and mortality. LDP for pancreatic cancer was performed rarely and will need critical evaluation in the future. Data from a prospective randomized registry trial is needed to confirm these results.
Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, 23538, Lübeck, Germany.
Ulrich Friedrich
UF
Wellner
Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, 23538, Lübeck, Germany.
Hryhoriy
H
Lapshyn
Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany.
Detlef K
DK
Bartsch
Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany.
Ioannis
I
Mintziras
Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany.
Ulrich Theodor
UT
Hopt
Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany.
Uwe
U
Wittel
Department of General, Visceral and Vascular Surgery, Evangelical Hospital of Düsseldorf, Düsseldorf, Germany.
Hans-Jörg
HJ
Krämling
Department of General, Visceral and Vascular Surgery, Evangelical Hospital of Düsseldorf, Düsseldorf, Germany.
Hubert
H
Preissinger-Heinzel
Department of General, Visceral and Transplantation Surgery,, Clinic Augsburg, Augsburg, Germany.
Matthias
M
Anthuber
Department of General, Visceral and Transplantation Surgery,, Clinic Augsburg, Augsburg, Germany.
Bernd
B
Geissler
Department of General, Visceral, Thoracic, and Transplantation Surgery, Katharinenhospital, Clinic Stuttgart, Stuttgart, Germany.
Jörg
J
Köninger
Department of General, Visceral, Thoracic, and Transplantation Surgery, Katharinenhospital, Clinic Stuttgart, Stuttgart, Germany.
Katharina
K
Feilhauer
Department of General and Visceral Surgery, Central Clinic Bad Berka, Bad Berka, Germany.
Merten
M
Hommann
Department of General and Visceral Surgery, Central Clinic Bad Berka, Bad Berka, Germany.
Luisa
L
Peter
Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology,, Clinic Neuperlach, Munich, Germany.
Natascha C
NC
Nüssler
Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology,, Clinic Neuperlach, Munich, Germany.
Thomas
T
Klier
Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany.|German Cancer Consortium (DKTK), Heidelberg, Germany.
Ulrich
U
Mansmann
Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, 23538, Lübeck, Germany. tobias.keck@uksh.de.
Tobias
T
Keck
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery; D019990:Perioperative Care; D057216:Propensity Score; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
Laparoscopic distal pancreatectomy; Open distal pancreatectomy; StuDoQ|pancreas registry