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)

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Summary

Introduction

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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