Abstract
Although laparoscopic distal pancreatectomy (LDP) has become more popular, the postoperative complication rate remains high. We sought to identify the risk factors for post-LDP complications. We examined 1227 patients who underwent LDP between March 2005 and December 2015 at a single large-volume center. We used logistic regression for the analysis. The overall (13.2%) and major (3.3%) complication rates were determined. Postoperative pancreatic fistula was the most frequent complication, and 58 patients (4.7%) had clinically significant (grade B) pancreatic fistulas. No 90-day mortality was recorded. Long operative time (≥200 min), large estimated blood loss (≥320 mL), LDP performed by an inexperienced surgeon (<50 cases), and concomitant splenectomy were identified as risk factors for overall complications using a logistic regression model. For major complications, male sex (p = 0.020), long operative time (p = 0.005), and LDP performed by an inexperienced surgeon (p = 0.026) were significant predictive factors. Using logistic regression analysis, surgery-related factors, including long operative time and LDP performed by an inexperienced surgeon, were correlated with overall and major complications of LDP. As LDP is a technically challenging procedure, surgery-related variables emerged as the main risk factors for postoperative complications. Appropriate patient selection and sufficient surgeon experience may be essential to reduce the complications of LDP.
Highlights
Laparoscopic distal pancreatectomy (LDP) has gained an increased popularity in recent years, and numerous reports have been published on the advantages of LDP as a treatment option for patients with left-sided pancreatic tumors
On the basis of a logistic regression model, long operative time (≥200 min), large estimated blood loss (≥320 mL), LDP performed by an inexperienced surgeon (
Male sex (p = 0.020), long operative time (p = 0.005), and LDP performed by an inexperienced surgeon (p = 0.026) were significant predictive factors (Table 4)
Summary
Laparoscopic distal pancreatectomy (LDP) has gained an increased popularity in recent years, and numerous reports have been published on the advantages of LDP as a treatment option for patients with left-sided pancreatic tumors. The laparoscopic approach has been reported to be safe and associated with less blood loss, more rapid recovery, shorter hospital stay, and comparable oncologic outcomes [1,2,3,4]. The most frequent complications after distal pancreatectomy are postoperative pancreatic fistula (POPF) and complicated fluid collection [5]; the determinants of post-LDP complications are poorly defined. In this study, we used a large single-center data set to analyze the risk factors for post-LDP complications and to determine the effects of patient characteristics, surgery-related factors, and pathologic findings on postoperative complications in patients undergoing LDP
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