Laparoscopic distal pancreatectomy should be the standard for neuroendocrine tumors. Analysis of a comparative study.

Abstract

Background: Although neuroendocrine tumors (NET)are an excellent indications for laparoscopic left pancreatectomy (LLP), however few studies are available comparing LLP to open left pancreatectomy (OLP) for NET.Our aim was to compare both approaches. Methods: Between January 2008 and Octobre 2015, 26 patients underwent LLP for NET. The laparoscopic approach (LA) was decided according to the surgeon expertise in laparoscopy but patients with very large tumor,adjacent organ invasion,and tumoral thrombus were excluded from the LA. These 26 were compared to 26 patients who underwent OLP and matched mainly on demographics data and the tumor size. LLP was compared to OLP. Results: No difference regarding age (54vs50;p=0,34), BMI(25 vs 23;p=0,26), female gender(69%vs60%; p=0,44), mean operative time(177vs172;p= 0.81), mean blood loss (244 vs 243;p=0.98), transfusion (4%vs7%; p=0.57) butless splenectomies (36%vs78%,p=0.002). No mortality. No difference in overall morbidity (65%vs52%, p=0.31), pancreatic fistula (50% vs 44%; p=0.68), re-intervention (4% vs 7%,p=0.55) and hospital stay (18vs20; p=0.62). Pathology showed no difference in the size (3.4 vs 2.9; p=0.55), the number of resected (7.4 vs 8.7;p=0.48) or invaded LN(0.23vs0.44; p=0.30). The mean survival was 44 (1-92) and 54(1-172) (p=0.086) months, and 5 year overall survival was 100% and 90%(p=0.43). Recurrence was observed in 1 (4.2%) and 5 (18.5%) patients (p= 0.112). Conclusion: This retrospective study shows that LLP should be the standard for the treatment of left sided NET.