Blood loss in laparoscopic distal pancreatectomy could be underestimated.

Abstract

Previous studies have reported that laparoscopic distal pancreatectomy (LDP) has an advantage in reducing blood loss over open distal pancreatectomy (ODP). This study was performed to investigate whether blood loss is truly reduced in LDP. A total of 113 patients undergoing DP from 2014 to 2022 were classified into Open and LDP groups and compared by statistical analysis. Estimated blood loss (EBL) was calculated from the perioperative changes in the hematocrit, hemoglobin, or red blood cell volume, and actual blood loss (ABL) was taken from the operative record. ABL was significantly lower in the LDP than ODP group (50[5-1350] vs 335 [5-1950] ml, P < .01). However, there were no significant differences in EBL calculated from the hematocrit (406 [66-1990] vs 540 [23-1490] ml, P=.14), hemoglobin, or red blood cell volume. EBL showed more linear correlations with ABL in the ODP group (r=0.64-0.73) than in the LDP group (r=0.52-0.57). In the multivariate analysis for ABL, ODP (P=.02) and operative time (P < .01) were significant factors. In contrast, no significant factors were found for EBL. Intraoperative blood loss may be underestimated in LDP, and a new evaluation method needs to be established.