Abstract
PurposeRecent studies have reported worse outcomes of converted laparoscopic distal pancreatectomy (CLDP) with respect to total laparoscopic (TLDP) and open (ODP). The aim of the study was to evaluate the impact of conversion on patient outcome and on total cost.MethodsPatients requiring a conversion (CLDP) were compared with both TLDP and ODP patients. The relevant patient- and tumour-related variables were collected for each patient. Both intra and postoperative data were extracted. Propensity score matching (PSM) analysis was carried out to equate the groups compared.ResultsTwo hundred and five patients underwent DP, 105 (51.2%) ODPs, 81 (39.5%) TLDPs, and 19 (9.3%) CLDPs. After PSM, 19 CLDPs, 38 TLDPs, and 38 ODPs were compared. Patients who underwent CLDP showed a significantly longer operative time (P < 0.001), and an increase in blood loss (P = 0.032) and total cost (P = 0.034) with respect to TLDP, and a significantly longer operative time (P < 0.001), less frequent postoperative morbidity (P = 0.050), and a higher readmission rate (P = 0.035) with respect to ODP.ConclusionTotal laparoscopic pancreatectomy was superior regarding operative findings and total costs with respect to CLDP; ODP showed a higher postoperative morbidity rate and a lower readmission rate with respect to CLDP. However, the reasons for the readmission of patients who underwent CLDP were mainly related to postoperative pancreatic fistula (POPF) grade B which is usually due to pancreas texture. Thus, the majority of distal pancreatectomies can be started using a minimally invasive approach, performing an early conversion if necessary.
Highlights
Laparoscopic distal pancreatectomy (LDP) is becoming the standard treatment for patients with left-sided pancreatic tumours from both a clinical and quality-of-life point of view [1]
Recent studies have shown that converted cases had increased overall postoperative morbidity, surgical site infections, prolonged length of stay, and 30-day mortality as compared to completed TLDPs, whereas they could be associated with similar outcomes when compared with planned ODPs [3, 7,8,9,10]
The current study, which included patients who underwent both laparoscopic and open approaches, showed, by using a propensity score matching analysis, that a converted laparoscopic distal pancreatectomy was related to worse outcomes with respect to patients who completed a laparoscopic distal pancreatectomy and to similar results with respect to patients who underwent planned ODP
Summary
Laparoscopic distal pancreatectomy (LDP) is becoming the standard treatment for patients with left-sided pancreatic tumours from both a clinical and quality-of-life point of view [1]. It represents a challenging procedure with different degrees of technical complexity and a high conversion. Riccardo Casadei and Carlo Ingaldi are shared the first authorship. Langenbeck's Archives of Surgery haemorrhage [PPH], delayed gastric emptying [DGE], reoperation rate, readmission rate, length of hospital stay), and the total cost of the surgical procedures
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