300 laparoscopic pancreatic resections the largest European single centre experience

Abstract

Background: Laparoscopic pancreatic resections (LPR) have become a routine procedure, but large single series are still lacking. Our aim was to analyze our large European single center series. Methods: Between January 2008 and September 2015, 300 LPR were performed and including165 (55%), distal pancreatectomies, 68 (23%) pancreatoduodenectomies (PD), 30 (10%) enucleations, 35 (11%) central pancreatectomies and 2 (1%) total pancreatecotomies. Results: Mean age was 54 years old (17-87) and most patients were women (58%). LPR was performed for malignancy (46%), low potential malignant (44%) or benign (10%) diseases. Surgery lasted a mean 211 min (30-540) and 351 (240-540) min for PD, and decreased with the learning curve. Mean blood loss was 229 ml (0-1500) and 13 patients (4%) were transfused. Conversion was required in 12 patients (4%). Mortality occurred in 4 (1.3%) patients and only after PD (5.8%). The most common complications were pancreatic fistula (n=124,41%), bleeding (n=35,12%) and reoperation (n=28,9%). The postoperative outcome was less favorable in procedures with a reconstruction phase (n=105) than in those without (n=195) with increased 90-day mortality (3.8%vs0%, p=0.04), overall morbidity (76%vs% 52%, p<0.001) and hospital stay (26vs16 days, p<0.001). Conclusion: This large study shows that LPR are safe with a low mortality and an acceptable morbidity. However, PD is associated with an increased rate of mortality and morbidity, thus limiting the benefits of this laparoscopic approach.