Short-term outcomes in open and laparoscopic distal pancreatectomy in a national cohort study

Abstract

Introduction: Distal pancreatectomy (DP) is increasingly performed by laparoscopy yet outcomes reported from unselected routine practice are scarce. We describe outcomes of laparoscopic and open DP in a complete cohort. Methods: A national cohort of all patients undergoing DP in a universal health care system (2012-2016) from the Norwegian Patient Register. Short-term outcomes for evaluation include aggregated length of stay (aLOS) and rates of reoperation, readmissions and mortality (90 days). Risk is reported as odds ratio with 95% confidence interval (OR, 95% CI). Results: Of 546 procedures, 323 (59%) were laparoscopic. DP rate increased during period. Median age was 66 years (IQR 55-72), with 52% being female (Table 1). Women (OR 1.43, 95% c.i. 1.02-2.02; P=0.039) and patients with higher Charlson comorbidity score (OR 0.56, 95% c.i. 0.32-0.99; P=0.045) were significantly more often selected to open DP. The majority of DPs were done for pancreatic tumours (n=258, 47%), of which 166 were done laparoscopic (64%). A splenectomy was included in 416 (76%) of all DPs, with no difference between open or laparoscopy groups. Reoperation rate at 30 days was 5.7% (n=31), with 4.3% for laparoscopic (n=14) and 7.6% for open DP (n=17). The median aLOS was 5.5 days shorter in laparoscopic to open DP (median 8.6 days vs 14.1; P< 0.001). Readmission rate was 20%, 90-day mortality was 1.1%. Conclusion: Laparoscopy is becoming the preferred access in a routine nationwide practice with reduction in length of stay but otherwise no difference in short-term outcomes. Readmission rate is high after DPs.Tabled 1FP15-06 Table 1VariableTotalOpen DPLap. DPPOR (95% CI)N=546N=223 (41%)N=323 (59%)Female, n (%) Male, n (%)284(52%) 264(48%)127 (57%) 96 (43%)155 (48%) 168 (52%).0391.43 (1.02-2.02)Age <65 yrs (n, %)255 (47%)104 (47%)151 (47%).9790.99 (0.71-1.40)Comorb. CCI >1 (n, %)52 (10%)28 (13%)24 (7%).0450.56 (0.32-0.99)Splenectomy, n (%)416 (76%)177 (79%)239 (74%).1470.74 (0.49-1.11Outcomes aLoS (median, iqr)9 (5-14)12 (8-19)7 (5-11)<.001n.a.Reoperations (n, %)31 (6%)17 (8%)14 (4%).1030.55 (0.27-1.14)Readmissions (n, %)107 (20%)42 (19%)65 (20%).7091.09 (0.71-1.67)Mortality 90-d, n (%)6 (1.1%)2 (0.9%)4 (1.2%).7071.39 (0.25-7.63) Open table in a new tab