Laparoscopic versus open central pancreatectomy: a propensity score-matched analysis in a single centre.

Abstract

Laparoscopic central pancreatectomy (LCP) has been implemented in pancreatic surgery; however, open surgery is still the predominant approach for central pancreatectomy (CP). Our objective was to compare LCP with open CP (OCP). Data were collected from patients with tumours located in the pancreatic neck and proximal body who underwent CP in the Department of Pancreatic Surgery West China Hospital from January 1, 2010, to June 30, 2019. A comparison between the LCP and OCP groups was performed. Fifteen patients underwent CP via the laparoscopic approach, and 96 patients underwent CP via the open approach. Using 1:2 propensity score matching (PSM), 12 patients in the LCP group were matched to 21 in the OCP group. Regarding safety, postoperative pancreatic fistula (POPF) was not significantly different between the two groups (13.3% vs. 12.5%, P = 1.000), even with PSM (16.7% vs. 14.3%, P = 1.000). However, regarding effectiveness, the operative time in the OCP group was significantly shorter than that in the LCP group before (307.0 ± 92.3ml vs. 220.6 ± 63.6ml, P < 0.000) and after (300.3 ± 90.2ml vs. 212.7 ± 44.4ml, P = 0.002) PSM. Regarding length of stay (LOS), there was no difference between the two groups before (13.1 ± 13.7days vs. 12.7 ± 10.1days, P = 0.376) and after PSM (14.4 ± 15.1days vs. 14.5 ± 16.2days, P = 0.985). The length of the resected pancreas was shorter in the OCP group than in the LCP group before PSM (50.0 ± 13.2mm vs. 41.1 ± 11.1mm, P = 0.043). However, there was no difference between the two groups after PSM (47.9 ± 12.5mm vs. 37.9 ± 10.4mm, P = 0.084). Moreover, the other variables showed no difference between the two groups before and after PSM. LCP can demonstrate similar safety and effectiveness to OCP, even in the early stages of the learning curve.