Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution

Lu Feng,Bing Peng,He Cai

doi:10.1186/s12893-021-01414-w

Abstract

ObjectiveTo investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques.MethodsWe retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted.ResultsTotally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3–63.0 years). The median BMI was 21.5 kg/m2 (IQR 19.7–24.0 kg/m2). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0–1000.0) vs. 50.0 (20.0–200.0) ml P < 0.001 and 100.0 (20.0–300.0) vs. 50.0 (20.0–200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041).ConclusionsOverall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.

Highlights

Pancreatectomy is the standard treatment for benign and low-grade malignant pancreatic tumors
What’s more, the only systematic review and meta-analysis of randomized controlled trials found that laparoscopic pancreaticoduodenectomy (LPD) showed no advantage over open pancreaticoduodenectomy (OPD) and more studies should focus on patient safety during learning curves [12]
Patients were grouped according to different surgical operations: laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), laparoscopic central pancreatectomy (LCP) and laparoscopic spleen-preserving distal pancreatectomy (LSPDP)

Summary

Introduction

Pancreatectomy is the standard treatment for benign and low-grade malignant pancreatic tumors. The first laparoscopic pancreatectomy for islet cell tumors of the pancreas was performed in 1992 [1]. During the following two decades, many studies have tried to demonstrate the safety and feasibility of laparoscopic pancreatectomy [2,3,4,5,6,7,8]. What’s more, the only systematic review and meta-analysis of randomized controlled trials found that laparoscopic pancreaticoduodenectomy (LPD) showed no advantage over open pancreaticoduodenectomy (OPD) and more studies should focus on patient safety during learning curves [12]. As a minimally invasive and parenchyma-sparing procedure, laparoscopic central pancreatectomy (LCP) has been regarded historically as an alternative technique for benign or low-grade malignant tumors of the neck of the pancreas [14]. LCP was challenge and had been rare reported worldwide [15]

Methods

Results

Discussion

Conclusion